title: Direct medical costs of COPD--an excess cost approach based on two population-based studies.
abstract: OBJECTIVE
  While it is known that severe COPD has substantial economic consequences, evidence on resource use and costs in mild disease is scarce. The objective of this study was to investigate excess costs of early stages of COPD.
  
  
  METHODS
  Using data from two population-based studies in Southern Germany, current GOLD criteria were applied to pre-bronchodilator spirometry for COPD diagnosis and staging in 2255 participants aged 41 to 89. Utilization of physician visits, hospital stays and medication was compared between participants with COPD stage I, stage II+ (II or higher) and controls. Costs per year were calculated by applying national unit costs. In controlling for confounders, two-part generalized regression analyses were used to account for the skewed distribution of costs and the high proportion of subjects without costs.
  
  
  RESULTS
  Utilization in all categories was significantly higher in COPD patients than in controls. After adjusting for confounders, these differences remained present in physician visits and medication, but not in hospital days. Adjusted annual costs did not differ between stage I (€ 1830) and controls (€ 1822), but increased by about 54% to € 2812 in stage II+.
  
  
  CONCLUSIONS
  The finding that utilization and costs are considerably higher in moderate but not in mild COPD highlights the economic importance of prevention and of interventions aiming at early diagnosis and delayed disease progression.
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany. petra.menn@helmholtz-muenchen.de
authors.forename: Petra
authors.initials: P
authors.lastname: Menn
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
authors.forename: Rudolf M
authors.initials: RM
authors.lastname: Huber
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Jörres
authors.forename: Jürgen
authors.initials: J
authors.lastname: John
authors.forename: Stefan
authors.initials: S
authors.lastname: Karrasch
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.forename: Holger
authors.initials: H
authors.lastname: Schulz
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D016527:Drug Costs / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics*; D012720:Severity of Illness Index