Healthcare utilization and costs in chronic cough

Abstract

Background

Chronic cough is a common reason for medical consultations and is associated with considerable physical and psychological morbidity. This study investigated healthcare use and cost in chronic cough and assessed its relationship with cough severity, health status, objective cough frequency (CF), and anxiety and depression.

Methods

This was a prospective study of consecutive patients with chronic cough from a specialist clinic who completed a cough severity visual analogue scale (VAS), cough-specific health status (Leicester Cough Questionnaire; LCQ) and general health status EuroQol EQ-5D-5L, Generalized Anxiety Disorder (GAD7), Patient Health Questionnaire (PHQ9), and 24-hour objective CF monitoring with Leicester Cough Monitor (LCM). Case notes were reviewed for cough-specific healthcare use 12 months before and after the first cough clinic consultation. Resource use included general practitioner and hospital clinic visits, investigations, and treatments. Unit costs for healthcare use were derived predominantly from National Health Service Reference Costs.

Results

One hundred participants with chronic cough were recruited (69% female, median duration 3 years, mean age 58 years). The diagnoses of cough were unexplained (57%), refractory (27%), and other (16%). Cough severity, health status, and CF were: median (IQR) VAS = 59.5 (30–79) mm, mean (SD) LCQ = 11.9 (4.0), mean (SD) EQ-5D-5L = 0.846 (0.178), and geometric mean (SD) CF = 15.3 (2.5) coughs/hr, respectively. The mean (SD) total cost per individual for cough-related healthcare utilization was £1,663 (747). Diagnostic investigations were the largest contributor to cost (63%), followed by cough clinic consultations (25%). In multivariate analysis, anxiety (GAD7) and cough-related health status (LCQ) were associated with increased cost (p ≤.001 and .037).

Conclusion

Healthcare cost associated with chronic cough are largely due to diagnostic investigations and clinic consultations. The predictors of costs were health status (LCQ) and anxiety. Further studies should investigate the optimal management protocols for patients with chronic cough.

Keywords:

• Cough
• healthcare utilization
• cost

Transparency

Declaration of funding

This work research was supported by Merck & Co., Inc. with an investigator research grant [58142].

Declaration of financial/other relationships

JS is reporting no potential competing interest other than the investigator research grant from Merck & Co., Inc. SC and AS are reporting no potential competing interest. PC is reporting a grant from EPSRC outside of the submitted work. MP is reporting consulting fees from Merck, and grants from NIHR and Hologic outside of the submitted work. SB is reporting consulting fees from Merck, Bayer, Shionogi and Bellus outside of the submitted work. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conception and design: SB, PC, JS, and MP; Data collection: PC, SC, and AS; Data analysis: PC, SB, JS, and MP; Interpretation of data: PC, SB, JS, MP, and AS; Drafting manuscript: PC, SB, JS, and MP; Revised manuscript: PC, JS, SC, AS, MP, and SB.

Acknowledgements

The authors would like to thank the participants, out-patient clinic staff, and respiratory physiologists for characterizing the participants and their assistance.