title: The impact of chronic obstructive pulmonary disease on long-term disability costs.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) as a cause of disability with subsequent costs remains poorly recognized. The small, growing body of literature on COPD shows that it is one of the leading causes of missed work.greater than asthma or diabetes. However, much less is known about the impact of COPD on long-term disability (LTD). Because the health care burden for disabled, working-age patients will fall heavily on managed care organizations, better estimates of the economic and pharmacoeconomic costs of COPD are required. We seek to improve understanding of the burden of COPD on several national LTD programs.
  
  
  METHODS
  We reviewed occupational health and disability literature and government statistics to determine how long-term, respiratory-related disability is addressed by disability pension programs in 8 developed countries (Canada, France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States). We then applied respiratory-specific disability definitions to country-specific population and pension information to estimate the potential burden of COPD on LTD insurance programs in each country.
  
  
  RESULTS
  Comprehensive, relevant data to evaluate respiratory-related disability are lacking. Of the study countries, only the United States has explicit respiratory specific criteria for disability eligibility, which are based solely on spirometry. We estimate that the total burden of COPD in the study countries may range from 5 billion dollars to as high as 25 billion dollars per year if all persons who met U.S. eligibility criteria for respiratory-related disability were granted compensation.
  
  
  CONCLUSIONS
  The potential burden of COPD on LTD programs may be large. The lack of standard criteria for respiratory-related disability may lead to underrecognition of COPD's true potential impact. Further work is needed to develop consistent and cost-effective ways to measure the impact of COPD and to assist in disability determination for COPD patients.
authors.affiliation: National Jewish Medical and Research Center, 1400 Jackson St., BB M306, Denver, CO 80206, USA. tinkelmand@NJC.org
authors.forename: David
authors.initials: D
authors.lastname: Tinkelman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nordyke
authors.forename: Sharon
authors.initials: S
authors.lastname: Isonaka
authors.forename: Dorothy
authors.initials: D
authors.lastname: George
authors.forename: Keith
authors.initials: K
authors.lastname: DesFosses
authors.forename: Dmitry
authors.initials: D
authors.lastname: Nonikov
mesh_terms: D017281:Cost of Illness; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D006801:Humans; D015397:Program Evaluation / Q000191:economics / Q000379:methods / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology*; D009626:Terminology as Topic; D013997:Time Factors