Healthcare and Societal Costs in Patients with COPD and Breathlessness after Completion of a Comprehensive Rehabilitation Program

Abstract

Breathlessness is one of the most frequent symptoms in chronic obstructive pulmonary disease (COPD). COPD may result in disability, decreased productivity and increased healthcare costs. The presence of comorbidities increases healthcare utilization. However, the impact of breathlessness burden on healthcare utilization and daily activities is unclear. This study’s goal was to analyze the impact of breathlessness burden on healthcare and societal costs. In this observational single-center study, patients with COPD were followed-up for 24 months after completion of a comprehensive pulmonary rehabilitation program. Every three months participants completed a cost questionnaire, covering healthcare utilization and impact on daily activities. The results were compared between participants with low (modified Medical Research Council (mMRC) grade <2; LBB) and high baseline breathlessness burden (mMRC grade ≥2; HBB). Healthcare costs in year 1 were €7302 (95% confidence interval €6476–€8258) for participants with LBB and €10,738 (€9141–€12,708) for participants with HBB. In year 2, costs were €8830 (€7372-€10,562) and €14,933 (€12,041–€18,520), respectively. Main cost drivers were hospitalizations, contact with other healthcare professionals and rehabilitation. Costs outside the healthcare sector in year 1 were €682 (€520–€900) for participants with LBB and €1520 (€1210–€1947) for participants with HBB. In year 2, costs were €829 (€662–€1046) and €1457 (€1126–€1821) respectively. HBB in patients with COPD is associated with higher healthcare and societal costs, which increases over time. This study highlights the relevance of reducing costs with adequate breathlessness relief. When conventional approaches fail to improve breathlessness, a personalized holistic approach is warranted.

Keywords:

• COPD
• breathlessness
• healthcare utilization
• societal costs

Disclosure statement

MvdB reports grants from ZonMW, during the conduct of the study. LEGWV reports grants and personal fees from AstraZeneca, personal fees from Novartis, personal fees from GSK, personal fees from Chiesi, personal fees from Menarini, personal fees from Pulmonx, personal fees from AGA Linde, personal fees from Boehringer, personal fees from Zambon, personal fees from Verona Pharma, outside the submitted work. FMEF reports grants and personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GlaxoSmithKline, grants and personal fees from Novartis, personal fees from TEVA, outside the submitted work. DJAJ reports grants from The Netherlands Organization for Health Research and Development (ZonMW), The Hague, The Netherlands (Grant number 836031012), during the conduct of the study; personal fees from Novartis, personal fees from Boehringer Ingelheim, personal fees from AstraZeneca, outside the submitted work. The remaining authors have no relevant conflicts to disclose.

Additional information

Funding

The manuscript was supported by an unrestricted research grant from Astra-Zeneca and The Netherlands Organization for Health Research and Development (ZonMW), The Hague, The Netherlands (Grant number 836031012).