title: Indirect costs in chronic obstructive pulmonary disease: a review of the economic burden on employers and individuals in the United States.
abstract: OBJECTIVE
  To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US.
  
  
  METHODS
  Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality.
  
  
  RESULTS
  Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987-2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%-18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27-63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3-19.4 days. Estimates of bed confinement range from 13-32 days per year. Estimated mean annual indirect costs were $893-$2,234/person (US dollars) with COPD ($1,521-$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%-61% of total costs, depending on the population studied.
  
  
  CONCLUSIONS
  COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD.
authors.affiliation: Pharmacy Administration and Public Health, University of Houston, Houston, TX, USA ; US Health Outcomes, GlaxoSmithKline, Durham, NC, USA.
authors.forename: Jeetvan G
authors.initials: JG
authors.lastname: Patel
authors.affiliation: US Health Outcomes, GlaxoSmithKline, Durham, NC, USA.
authors.forename: Saurabh P
authors.initials: SP
authors.lastname: Nagar
authors.affiliation: US Health Outcomes, GlaxoSmithKline, Durham, NC, USA.
authors.forename: Anand A
authors.initials: AA
authors.lastname: Dalal
mesh_terms: D000041:Absenteeism; D001510:Bed Rest / Q000191:economics; D017028:Caregivers / Q000191:economics; D017281:Cost of Illness; D004185:Disability Evaluation; D004526:Efficiency; D017049:Employer Health Costs; D006801:Humans; D007182:Income; D051346:Mobility Limitation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy; D018582:Sick Leave / Q000191:economics*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: chronic obstructive pulmonary disease; disability; economics; indirect costs; productivity