Economic burden of COPD in a Swedish cohort: the ARCTIC study

Abstract

Background

We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting.

Patients and methods

Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed.

Results

A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179) versus the reference population (€2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient) were the largest economic burden in COPD patients of working age during 2013.

Conclusion

As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.

Keywords:

• COPD
• direct cost
• indirect cost
• burden
• Sweden

Acknowledgments

The authors were assisted in the preparation of the manuscript by Chris Cammack PhD and David McMinn PhD, professional medical writers at CircleScience, an Ashfield Company, part of UDG Healthcare plc (Tytherington, UK). The statistical analyses and medical writing support were funded by Novartis Pharma AG (Basel, Switzerland). The abstract of this paper was presented at the Nordic Lung Congress (NLC) 2017 as a poster presentation (P215) with interim findings (http://www.nlc2017.se/doc/Poster%20 session%20II.pdf); European Respiratory Society (ERS) International Congress 2016 as a poster presentation with interim findings and the poster abstract (PA3926) was published in “Poster Abstracts” in European Respiratory Journal (http://erj.ersjournals.com/content/48/suppl_60/PA3926, doi: 10.1183/13993003.congress-2016); International Primary Care Respiratory Group (IPCRG) Conference 2016 as an oral presentation with interim findings and the poster abstract (CR065) was published in “Poster Abstracts” in npj Primary Care Respiratory Medicine (https://images.nature.com/full/nature-assets/npjpcrm/abstracts/npjpcrm201622.pdf, doi:10.1038/npjpcrm.2016.22).

Disclosure

Karin Lisspers has received honoraria for educational activities and lectures from AstraZeneca, GlaxoSmithKline, Novartis, MEDA, and Takeda and has served on advisory boards arranged by MEDA and Novartis. She has also participated in the steering committee for this study funded by Novartis. Kjell Larsson has, during the last 5 years, on one or more occasion served in an advisory board, served as a speaker, and/or participated in education arranged by AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Takeda, Novartis, Chiesi, Orion and Teva. Gunnar Johansson has participated in the steering committee organized by Novartis for this study and served on advisory boards arranged by Astra Zeneca, Novo Nordisk, and Takeda. Christer Janson has received honoraria for educational activities and lectures from Novartis, AstraZeneca, Glaxo-SmithKline, and Boehringer Ingelheim outside the submitted work. Björn Ställberg has received honoraria for educational activities and lectures from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, MEDA, and TEVA and has served on advisory boards arranged by AstraZeneca, Novartis, GSK, Boehringer Ingelheim and MEDA. Florian S Gutzwiller, and Jean-Bernard Gruenberger are employees of Novartis Pharma AG. Madlaina Costa-Scharplatz is an employee of Novartis AB. Milica Uhde and Leif Jorgensen are employees of IQVIA, who received remuneration in relation to statistical analysis. The authors report no other conflicts of interest in this work.