title: COPD symptom burden: impact on health care resource utilization, and work and activity impairment.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) can greatly impact the quality of life by limiting patients' activities. However, data on impact of symptomatic burden on the health care resource utilization (HCRU) and employment in COPD are lacking. We examined the association between COPD Assessment Test (CAT) score and direct/indirect costs associated with HCRU and work productivity.
  
  
  METHODS
  Data from >2,100 patients with COPD consulting for routine care were derived from respiratory disease-specific programs in Europe, the USA and China. Questionnaires, including CAT and Work Productivity and Activity Impairment (WPAI), were used to collect the past and current disease status data and HCRU characteristics from physicians (general practitioners/specialists) and patients. A regression approach was used to quantify the association of CAT with HCRU and WPAI variables. CAT score was modeled as a continuous independent variable (range: 0-40).
  
  
  RESULTS
  Ninety percent of patients with COPD had a CAT score ≥10. Short-acting therapy and maintenance bronchodilator monotherapy, respectively, were currently prescribed to patients with CAT scores of 10-19 (5.8% and 27.6%), 20-29 (5.1% and 13.1%) and 30-40 (2.8% and 6.6%). Prescribing of maintenance bronchodilator dual therapy was low across the CAT score groups (0-9, 7.8%; 10-19, 6.4%; 20-29, 5.9%; 30-40, 4.4%), whereas maintenance triple combination therapy was prescribed more commonly in patients with higher CAT scores (0-9, 16.1%; 10-19, 23.2%; 20-29, 25.9%; 30-40, 35.5%). Increasing CAT scores were significantly associated with a higher frequency of primary care physician visits (P<0.001), pulmonologist visits (P=0.007), exacerbations requiring hospitalization (P<0.001) and WPAI scores (P<0.001).
  
  
  CONCLUSIONS
  Most patients with COPD presented with high symptom levels, despite being treated for COPD. Increasing symptom burden was associated with increasing HCRU and had a detrimental impact on work productivity.
authors.affiliation: Medical Evidence and Observational Research, AstraZeneca Gothenburg, Mölndal, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Ding
authors.affiliation: Real World Research (Respiratory), Adelphi Real World, Bollington, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Small
authors.affiliation: Global Payer Evidence and Pricing, AstraZeneca Gothenburg, Mölndal, Sweden.
authors.forename: Gina
authors.initials: G
authors.lastname: Bergström
authors.affiliation: Global Payer Evidence and Pricing, AstraZeneca Gothenburg, Mölndal, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Holmgren
mesh_terms: D000041:Absenteeism; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002681:China; D017281:Cost of Illness; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004526:Efficiency; D004651:Employment / Q000191:economics; D005060:Europe; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010343:Patient Admission; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology* / Q000628:therapy*; D015272:Pulmonary Medicine; D018582:Sick Leave; D011795:Surveys and Questionnaires; D014481:United States; D014938:Work Capacity Evaluation
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; health care resource utilization; routine care; symptom; work and activity impairment