title: Rising Costs of COPD and the Potential for Maintenance Therapy to Slow the Trend.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) affects an estimated 14% of adults in the United States between the ages of 40 and 79 years. This progressive disease is characterized by persistent airflow limitation. The management of patients with COPD is focused on reducing risk factors, relieving symptoms, and preventing exacerbations.
  
  
  OBJECTIVE
  To examine the peer-reviewed literature on the impact of maintenance therapy on the direct treatment costs of patients with COPD in the United States.
  
  
  METHODS
  PubMed was searched for articles written in English that were published between 2000 and 2013, using the search terms "COPD," "economics," "exacerbation," "maintenance," and related terms. Articles reporting the results of longitudinal studies of the costs associated with the management of patients with COPD, the costs associated with hospitalizations for acute exacerbations of COPD, and randomized clinical trials evaluating the effects of maintenance therapy on the incidence of COPD exacerbations were included in this review.
  
  
  RESULTS
  The search identified a total of 277 articles, and 11 of these articles were deemed appropriate for inclusion in this review. The direct healthcare costs for patients with COPD increased by 38% between 1987 and 2007, and continued to increase by approximately 5% annually between 2006 and 2009. The costs associated with hospital admissions for patients with COPD accounted for the largest absolute increase ($2289 per admission in constant 2007 US dollars). Recent estimates suggest that the aggregate costs associated with the treatment of acute exacerbations are between $3.2 billion and $3.8 billion, and that annual healthcare costs are 10-fold greater for patients with COPD associated with acute exacerbations than for patients with COPD but without exacerbations. The results of 2 large clinical trials of maintenance therapy, including a long-acting cholinergic antagonist or a long-acting beta-2 agonist, showed a 16% to 17% reduction in the incidence of exacerbations compared with placebo. Nevertheless, maintenance therapy remains underutilized, with only 30% to 35% of patients with COPD in private and public health insurance plans receiving prescriptions for maintenance therapy.
  
  
  CONCLUSIONS
  The treatment of acute exacerbations of COPD remains the major driver of increasing healthcare costs associated with this condition. The appropriate use of maintenance therapy has been shown to reduce the incidence of exacerbations and has the potential to reduce overall costs associated with the management of patients with COPD.
authors.affiliation: Research Associate Professor, Department of Public Health Sciences, College of Health & Human Services, University of North Carolina at Charlotte, and Director, Health Economics & Outcomes Research, Otsuka America Pharmaceutical, Inc, Charlotte, NC.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Blanchette
authors.affiliation: President and CEO, University Medical Research, LLC, Farmington, CT.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Gross
authors.affiliation: Medical Director, Medical Affairs, Mylan Specialty LP, Basking Ridge, NJ, at the time of writing.
authors.forename: Pablo
authors.initials: P
authors.lastname: Altman