title: Clinical characteristics, treatment patterns, and socio-economic burden of COPD in Bulgaria.
abstract: BACKGROUND
  While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case.
  
  
  METHODS
  A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed.
  
  
  RESULTS
  A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times.
  
  
  CONCLUSIONS
  Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.
authors.affiliation: a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria.
authors.forename: Maria
authors.initials: M
authors.lastname: Kamusheva
authors.affiliation: a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria.
authors.forename: Maria
authors.initials: M
authors.lastname: Dimitrova
authors.affiliation: b Department of General Practice , Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.|c Unit of Pharmacotherapy , Epidemiology and - Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.
authors.forename: Job F M
authors.initials: JF
authors.lastname: van Boven
authors.affiliation: c Unit of Pharmacotherapy , Epidemiology and - Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.|d Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen , Groningen , The Netherlands.|e Department of Epidemiology , University Medical Center Groningen (UMCG), University of Groningen , Groningen , The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: b Department of General Practice , Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: b Department of General Practice , Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.|f Department of General Practice , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.
authors.forename: Janwillem W H
authors.initials: JW
authors.lastname: Kocks
authors.affiliation: a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Mitov
authors.affiliation: a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria.
authors.forename: Miglena
authors.initials: M
authors.lastname: Doneva
authors.affiliation: g Department of Propaedeutic of Internal Diseases , UMHAT 'Alexandrovska', Medical University , Sofia , Bulgaria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Petrova
authors.affiliation: g Department of Propaedeutic of Internal Diseases , UMHAT 'Alexandrovska', Medical University , Sofia , Bulgaria.
authors.forename: Ognyan
authors.initials: O
authors.lastname: Georgiev
authors.affiliation: a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria.
authors.forename: Valentina
authors.initials: V
authors.lastname: Petkova
authors.affiliation: a Department of Organization and Economics of Pharmacy, Faculty of Pharmacy , Medical University of Sofia , Sofia , Bulgaria.
authors.forename: Guenka
authors.initials: G
authors.lastname: Petrova
mesh_terms: D000041:Absenteeism; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000706:statistics & numerical data; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use; D002031:Bulgaria / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D016273:Occupational Exposure / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; burden; costs; epidemiology; prevalence