The burden of illness in patients with moderate to severe chronic obstructive pulmonary disease in Canada.
BACKGROUND
No recent Canadian studies with physician- and spirometry-confirmed diagnosis of chronic obstructive pulmonary disease (COPD) that assessed the burden of COPD have been published.


OBJECTIVE
To assess the costs associated with maintenance therapy and treatment for acute exacerbations of COPD (AECOPD) over a one-year period.


METHODS
Respirologists, internists and family practitioners from across Canada enrolled patients with an established diagnosis of moderate to severe COPD (Global initiative for chonic Obstructive Lung Disease stages 2 and 3) confirmed by postbronchodilator spirometry. Patient information and health care resources related to COPD maintenance and physician-documented AECOPD over the previous year were obtained by chart review and patient survey.


RESULTS
A total of 285 patients (59.3% male; mean age 70.4 years; mean pack years smoked 45.6; mean duration of COPD 8.2 years; mean postbronchodilator forced expiratory volume in 1 s 58.0% predicted) were enrolled at 23 sites across Canada. The average annual COPD-related cost per patient was $4,147. Across all 285 patients, maintenance costs were $2,475 per patient, of which medications accounted for 71%. AECOPD treatment costs were $1,673 per patient, of which hospitalizations accounted for 82%. Ninety-eight patients (34%) experienced a total of 157 AECOPD. Treatment of these AECOPD included medications and outpatient care, 19 emergency room visits and 40 hospitalizations (mean length of stay 8.9 days). The mean cost per AECOPD was $3,036.


CONCLUSIONS
The current costs associated with moderate and severe COPD are considerable and will increase in the future. Appropriate use of medications and strategies to prevent hospitalizations for AECOPD may reduce COPD-related costs because these were the major cost drivers.
Department of Medicine, Women's College Hospital, University of Toronto, Ontario, Canada. maleki.pccrc@on.aibn.com
M Reza
MR
Maleki-Yazdi
Suzanne M
SM
Kelly
S Ys
SY
Lam
Mihaela
M
Marin
Martin
M
Barbeau
Valery
V
Walker
D000368:Aged; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology