COPD management costs according to the frequency of COPD exacerbations in UK primary care.
COPD management costs according to the frequency of COPD exacerbations in UK primary care.
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DOI：
10.2147/copd.s54417
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发表时间：
2014
影响因子：
2.8
通讯作者：
Müllerova H
中科院分区：
文献类型：
--
作者：
Punekar YS;Shukla A;Müllerova H
慢性阻塞性肺疾病（COPD）急性加重的经济负担是显著的，但其他来源对COPD管理总成本的影响在很大程度上是未知的。我们的目的是估计在英国每年没有、一次或两次或更多次急性加重的患者的总成本。在英国临床实践研究数据链数据库中确定了一个回顾性COPD患者队列。纳入了在队列入组日期前后至少12个月内记录信息的患者（2009年4月1日/之后通过肺量测定法确认的首次流行COPD诊断）。患者在入组后12个月内被分类为无、有1次或2次或2次以上中度至重度COPD急性加重，并根据慢性阻塞性肺疾病全球倡议（GOLD）气流阻塞类别和医学研究理事会呼吸困难量表进一步分类。研究结局包括全科医生相互作用、中重度COPD急性加重和非COPD住院次数。估计资源使用成本是使用2010-2011年国家卫生服务参考成本计算的。该队列包括58，589例患者（平均年龄69.5岁，平均呼吸困难2.5级，女性46.6%，当前吸烟者33.1%）。所有患者的COPD管理（不包括药物）的平均年度总成本为2，108英镑，未发生、发生1次或2次或2次以上中度至重度急性加重的患者分别为1，523英镑、2，405英镑和3，396英镑。全科医生的相互作用对这些年度成本贡献最大，在没有、一次或两次或多次中重度急性加重的患者中分别占1，062英镑（69.7%）、1，313英镑（54.6%）和1，592英镑（46.9%）。注重降低初级保健成本的疾病管理策略可能有助于显著降低COPD总成本。
The economic burden of chronic obstructive pulmonary disease (COPD) exacerbations is significant, but the impact of other sources on the overall cost of COPD management is largely unknown. We aimed to estimate overall costs for patients experiencing none, one, or two or more exacerbations per year in the UK. A retrospective cohort of prevalent COPD patients was identified in the Clinical Practice Research Datalink UK database. Patients with information recorded for at least 12 months before and after cohort entry date were included (first prevalent COPD diagnosis confirmed by spirometry on/after April 1, 2009). Patients were categorized as having none, one, or two or more moderate-to-severe COPD exacerbations in the 12 months after cohort entry and further classified by the Global initiative for chronic Obstructive Lung Disease (GOLD) category of airflow obstruction and the Medical Research Council dyspnea scale. Study outcomes included counts of general practitioner interactions, moderate-severe COPD exacerbations, and non-COPD hospitalizations. Estimated resource use costs were calculated using National Health Service reference costs for 2010–2011. The cohort comprised 58,589 patients (mean age 69.5 years, mean dyspnea grade 2.5, females 46.6%, current smokers 33.1%). The average total annual per patient cost of COPD management, excluding medications, was £2,108 for all patients and £1,523, £2,405, and £3,396 for patients experiencing no, one, or two or more moderate-to-severe exacerbations, respectively. General practitioner interactions contributed most to these annual costs, accounting for £1,062 (69.7%), £1,313 (54.6%), and £1,592 (46.9%) in patients with no, one, or two or more moderate-to-severe exacerbations, respectively. Disease management strategies focused on reducing costs in primary care may help reduce total COPD costs significantly.