Direct medical costs of COPD – An excess cost approach based on two population-based studies

Menn, Petra; Heinrich, Joachim; Huber, Rudolf M.; Jörres, Rudolf A.; John, Jürgen; Karrasch, Stefan; Peters, Annette; Schulz, Holger; Holle, Rolf; for the KORA Study Group,

doi:10.1016/j.rmed.2011.10.013

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Volume 106, Issue 4 , Pages 540-548, April 2012

Direct medical costs of COPD – An excess cost approach based on two population-based studies

Petra Menn
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
- Corresponding author. Tel.: +49 89 3187 4166; fax: +49 89 3187 3375.
Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
Rudolf M. Huber
- Division of Respiratory Medicine, University of Munich – Campus Innenstadt, Ziemssenstr. 1, 80336 Munich, Germany
Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University of Munich – Campus Innenstadt, Ziemssenstr. 1, 80336 Munich, Germany
Jürgen John
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University of Munich – Campus Innenstadt, Ziemssenstr. 1, 80336 Munich, Germany
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
- The KORA study group consists of H.-E. Wichmann (speaker), R. Holle, J. John, T. Illig, C. Meisinger, A. Peters, and their coworkers, who are responsible for the design and conduct of the KORA studies.
for the KORA Study Group

Received 18 July 2011; accepted 31 October 2011. published online 21 November 2011.

Summary

Aim

While it is known that severe COPD has substantial economic consequences, evidence on resource use and costs in mild disease is scarce. The objective of this study was to investigate excess costs of early stages of COPD.

Methods

Using data from two population-based studies in Southern Germany, current GOLD criteria were applied to pre-bronchodilator spirometry for COPD diagnosis and staging in 2255 participants aged 41 to 89. Utilization of physician visits, hospital stays and medication was compared between participants with COPD stage I, stage II+ (II or higher) and controls. Costs per year were calculated by applying national unit costs. In controlling for confounders, two-part generalized regression analyses were used to account for the skewed distribution of costs and the high proportion of subjects without costs.

Results

Utilization in all categories was significantly higher in COPD patients than in controls. After adjusting for confounders, these differences remained present in physician visits and medication, but not in hospital days. Adjusted annual costs did not differ between stage I (€ 1830) and controls (€ 1822), but increased by about 54% to € 2812 in stage II+.

Conclusion

The finding that utilization and costs are considerably higher in moderate but not in mild COPD highlights the economic importance of prevention and of interventions aiming at early diagnosis and delayed disease progression.

Keywords: Chronic obstructive pulmonary disease, Cost and cost analysis, Utilization, Population-based study, Health-economic impact