Assessment of the Economic Burden of COPD in the U.S.: A Review and Synthesis of the Literature

Figures & data

Table 1 Methodologies and analytical approaches in literature reviewed

Reference	Stated perspective	Costing approach	Base year for costs
Annual national costs
Ward et al. 2000 ([17])	Public-payer	Attributable	1994
Wilson et al. 2000 ([14])	Societal	Attributable	1996
Leigh et al. 2002 ([15])	Societal	Attributable	1996
NHLBI 2004 ([8])	Societal	Attributable	2004
Annual per-patient costs
Grasso et al. 1998 ([12])	Medicare	Excess	1992
Hilleman et al. 2000 ([11])	Single university health system	Attributable	1999
Mapel et al. 2000 ([22])	Managed care	Excess	1997
Wilson et al. 2000 ([14])	Societal	Attributable	1996
Strassels et al. 2001 ([21])	Societal	Attributable	1997
Halpern et al. 2003 ([9])	Societal	Attributable	1999
Stuart et al. 2004 ([18])	Medicare	Attributable	2000
Marton et al. 2006 ([6])	Medicaid	Attributable and excess	2001
Miller et al. 2005 ([7])	All-payer	Attributable and excess	2000

Table 2 Annual national direct medical costs of COPD

Reference	Cost components	Base year for costs	Base year $ (millions)	2005 $ (millions)
Ward et al. 2000 ([17])	Inpatient	1994	$2,836	$4,344
	Outpatient		$3,277	$5,020
	Pharmacy		$462	$708
	Total		$6,575	$10,071
Wilson et al. 2000 ([14])	Inpatient	1996	$8,384	$11,874
	Outpatient		$1,044	$1,479
	Pharmacy		$5,064	$7,172
	Total		$14,492	$20,525
Leigh et al. 2002 ([15])
	Total	1996	$18,634	$26,391
NHLBI 2004 (8)	Inpatient	2004	$11,400	$11,882
	Outpatient		$4,500	$4,690
	Pharmacy		$5,000	$5,211
	Total		$20,900	$21,783

Table 3 Annual per-patient direct medical costs of COPD

Reference	Cost Components	Base Year for Costs	Base Year $ (millions)	2005 $ (millions)
Grasso et al. 1998 ([12])	Inpatient	1992	$3,408	$5,794
	Outpatient		$1,563	$2,657
	Pharmacy		n/a	n/a
	Total		$4,971	$8,451
Hilleman et al. 2000^1 ([11])	Inpatient	1999	$2,553	$3,293
	Outpatient		$1,420	$1,831
	Pharmacy		$625	$806
	Total		$4,598	$5,930
Mapel et al. 2000 ([22])	Inpatient	1997	$3,067	$4,225
	Outpatient		$1,996	$2,750
	Pharmacy		$806	$1,110
	Total		$5,869	$8,086
Wilson et al. 2000 ([14])	Inpatient	1996	$708	$1,002
	Outpatient		$60	$85
	Pharmacy		$320	$453
	Total		$1,088	$1,540
Strassels et al. 2001 ([21])	Inpatient	1987	$1232	$3061
	Outpatient		$257	$638
	Pharmacy		$176	$437
	Total^2		$1665	$4136
Halpern et al. 2003 ([9])	Inpatient	1999	$2891	$3729
	Outpatient		$1025	$1322
	Pharmacy		$202	$261
	Total		$4118	$5311
Stuart et al. 2004^3 ([18])	Inpatient	2000	$663	$821
	Outpatient		$67	$83
	Pharmacy		$256	$317
	Total		$985	$1221
Marton et al. 2006 (excess cost)^4 ([6])	Inpatient	2001	$2,912	$3,450
	Outpatient		$1,115	$1,321
	Pharmacy		$1,535	$1,818
	Total		$5,561	$6,589
Marton et al. 2006 (attributable cost) ([6])	Total	2001	$2,289	$2,712
Miller et al. 2005 (excess cost) ([7])	Inpatient	2000	$3,298	$4,087
	Outpatient		$1,550	$1,921
	Pharmacy		$796	$986
	Total unadjusted		$5,645	$6,996
	Total adjusted^5		$4,932	$6,112
Miller et al. 2005 (attributable cost) ([7])	Inpatient	2000	$1,365	$1,692
	Outpatient		$767	$951
	Pharmacy		$375	$465
	Total		$2,507	$3,107

¹Hilleman et al. stratified costs by COPD disease severity. To estimate costs across all levels of severity, a weighted average was calculated (see the Methods section).

²Total differs from the sum of the components due to rounding.

³Stuart et al. stratified costs by prescription drug coverage. To estimate costs for both coverage groups, a weighted average was calculated (see the Methods section).

⁴Marton et al. reported costs for Florida and California patients separately. To estimate costs for all patients, a weighted averaged was calculated (see the Methods section).

⁵Miller et al. used multivariate linear least-squares regression to adjust for potentially confounding factors.

Figure 1 Estimated annual per-patient direct medical costs of COPD ($US 2005) by first author of study and base year of estimate. Excess costs = difference between medical expenditure of patients with and without COPD. Attributable costs = costs directly attributable based on diagnosis codes for COPD.

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