title: Direct and indirect costs of COPD and its comorbidities: Results from the German COSYCONET study.
abstract: BACKGROUND
  Reliable up-to-date estimates regarding the economic impact of chronic obstructive pulmonary disease (COPD) are lacking. This study investigates COPD excess healthcare utilization, work absenteeism, and resulting costs within the German COPD cohort COSYCONET.
  
  
  METHODS
  Data from 2139 COPD patients in GOLD grade 1-4 from COSYCONET were compared with 1537 lung-healthy control subjects from the population-based KORA platform. Multiple generalized linear models analyzed the association of COPD grades with healthcare utilization, work absence, and costs from a societal perspective while adjusting for sex, age, education, smoking status, body mass index (BMI), and several comorbidities.
  
  
  RESULTS
  COPD was significantly associated with excess healthcare utilization, work absence, and premature retirement. Adjusted annual excess cost of COPD in 2012 for GOLD grade 1-4 amounted to €2595 [1770-3678], €3475 [2966-4102], €5955 [5191-6843], and €8924 [7190-10,853] for direct costs, and €8621 [4104-13,857], €9871 [7692-12,777], €16,550 [13,743-20,457], and €27,658 [22,275-35,777] for indirect costs respectively. Comorbidities contributed to the primary effect of COPD on direct costs only. An additional history of cancer or stroke had the largest effect on direct costs, but the effects were smaller than those of COPD grade 3/4.
  
  
  CONCLUSIONS
  COPD is associated with substantially higher costs than previously reported.
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany. Electronic address: margarethe.wacker@helmholtz-muenchen.de.
authors.forename: M E
authors.initials: ME
authors.lastname: Wacker
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336 Munich, Germany.
authors.forename: R A
authors.initials: RA
authors.lastname: Jörres
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schulz
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Heinrich
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336 Munich, Germany; Institute of Epidemiology I, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany; Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667 Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Karrasch
authors.affiliation: Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Karch
authors.affiliation: Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Koch
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Peters
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany; Institute of Health Economics and Health Care Management, Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Ludwigstr. 28/RG, 80539 Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Leidl
authors.affiliation: Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Baldingerstraße, 35043 Marburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Vogelmeier
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Holle
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology*
keywords: COPD; Comorbidity; Cost; Healthcare