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

Figures & data

Figure 1. Flow chart.

Table 1. Baseline characteristics of total study population and participants with low and high breathlessness burden.

	Total group (n = 178)	Low breathlessness burden (n = 82)	High breathlessness burden (n = 96)	p-value^a
Age (years)	63.6 ± 7.0	62.8 ± 7.6	64.2 ± 6.4	0.183
Male, n (%)	107 (60.1)	48 (58.5)	59 (61.5)	0.692
BMI (kg/m^2)	26.7 ± 5.4	26.5 ± 4.4	27.0 ± 6.1	0.821
Smoking status, n (%)				0.161
Ex-smoker	144 (80.9)	70 (85.4)	74 (77.1)
Smoker	34 (19.1)	12 (14.6)	22 (22.9)
Exacerbations in <12 months (n)	1.4 ± 1.6	0.9 ± 1.2	1.8 ± 1.9	0.002
Hospital admissions in <12 months (n)	0.5 ± 1.1	0.4 ± 0.9	0.6 ± 1.2	0.206
CCI (points)	1.6 ± 0.9	1.4 ± 0.7	1.8 ± 1.0	0.007
FEV1, (l)	1.42 ± 0.56	1.56 ± 0.54	1.30 ± 0.54	<0.001

Data are shown as mean (SD). Significance testing was performed using Mann-Whitney U tests or χ² tests as appropriate.

BMI = body mass index; CCI = Charlson comorbidity index; FEV₁ = forced expiratory volume in 1 s.

^a Significant p-values are shown in bold.

Table 2. Healthcare and non-healthcare utilization per participant per year.

	Low breathlessness burden				High breathlessness burden				p-value^a
	N = 82 (46.1%)				N = 96 (53.9%)
	Total	Breathing problems	Other health problems	p-value^a	Total	Breathing problems	Other health problems	p-value^a
Outpatient care
% User	100.0	100.0	100.0	1.000	100.0	100.0	100.0	1.000	1.000
Total number of visits	96.5 (35.0)	85.0 (32.2)	11.5 (12.6)	<0.001	111.1 (55.7)	95.8 (49.5)	14.2 (18.2)	<0.001	0.060
Family doctor	8.9 (5.1)	4.2 (3.7)	4.8 (3.4)	0.204	12.3 (9.3)	7.1 (6.7)	5.2 (4.5)	0.039	0.015
Medical specialist	6.4 (5.8)	3.8 (4.0)	2.6 (4.1)	0.004	7.0 (4.8)	4.5 (4.1)	2.6 (2.6)	<0.001	0.042
Other healthcare professional	81.2 (33.5)	77.1 (31.5)	4.1 (9.7)	<0.001	90.8 (53.3)	84.3 (48.8)	6.5 (14.7)	<0.001	0.152
Inpatient care
% User	57.3	42.7	32.9	0.216	71.9	64.6	35.4	<0.001	0.042
Ambulance transportation	0.20 (0.60)	0.16 (0.59)	0.04 (0.13)	0.027	0.34 (0.75)	0.26 (0.73)	0.07 (0.22)	0.009	0.145
Visit to emergency room	0.37 (0.58)	0.21 (0.44)	0.16 (0.34)	0.477	0.67 (0.96)	0.51 (0.84)	0.16 (0.36)	<0.001	0.016
Hospitalizations	0.51 (0.78)	0.34 (0.63)	0.17 (0.36)	0.023	1.16 (1.71)	0.73 (1.24)	0.43 (1.18)	0.001	0.005
Diagnostics
% User	–	96.3	–	–	–	94.8	–	–	0.619
Respiratory tests	–	3.0 (1.9)	–	–	–	3.7 (2.7)	–	–	0.199
Medication
Number of prescribed medications	25.7 (13.1)	13.0 (10.1)	12.7 (6.6)	0.590	33.1 (18.7)	19.0 (14.1)	14.1 (7.5)	0.003	0.009
% Short-acting bronchodilators	–	61.0	–	–	–	82.3	–	–	0.002
% Long-acting bronchodilators	–	98.8	–	–	–	100.0	–	–	0.287
% Inhaled corticosteroids	–	89.0	–	–	–	94.8	–	–	0.154
% Systemic corticosteroids^b	75.6	69.5	17.1	<0.001	85.4	84.4	24.0	<0.001	0.097
% Antibiotics	85.4	76.8	42.7	<0.001	84.4	80.2	29.2	<0.001	0.854
% Influenza vaccination	–	93.9	–	–	–	88.5	–	–	0.213
% Cardiac medication	–	–	59.8	–	–	–	71.9	–	0.088
% Strong opioids^c	7.3	1.2	7.3	0.063	11.5	4.2	8.3	0.344	0.349
LTOT
% User	–	39.0	–	–	–	54.2	–	–	0.044
LTOT^d	–	23.5 (18.8)	–	–	–	28.3 (17.0)	–	–	0.159
Inability of participant to perform daily activities
% That was unable	90.2	82.9	46.3	<0.001	99.0	97.9	56.3	<0.001	0.008
Days of inability	30.0 (42.9)	21.5 (8.8)	8.6 (18.2)	<0.001	75.5 (84.2)	64.6 (83.4)	10.9 (20.9)	<0.001	<0.001
Inability of informal caregiver to perform daily activities
% That was unable	18.3	14.6	6.1	0.092	30.2	27.1	12.5	0.003	0.066
Days of inability	3.1 (11.2)	2.7 (10.9)	0.4 (1.8)	0.094	8.1 (34.9)	7.8 (34.8)	0.3 (1.6)	<0.001	0.064

Data are shown as mean (SD). Significance testing was performed using Mann-Whitney U tests, Wilcoxon signed rank tests or χ² tests as appropriate.

^a Significant p-values are shown in bold.

^b Use of both continuous and intermittent systemic corticosteroids.

^c Strong opioids include: fentanyl, morphine, oxycodone, and piritramide.

^d Only considering participants that used LTOT.

LTOT = long-term oxygen therapy.

Table 3. Mean costs per participant per year (in Euro’s).

	Low breathlessness burden			High breathlessness burden
	N = 82 (46.1%)			N = 96 (53.9%)
	Year 1	Year 2	p-value^a	Year 1	Year 2	p-value^a
Healthcare costs
Outpatient	3527	3634	0.844	3792	4166	0.200
Inpatient	1606	1876	0.672	3934	3910	0.776
Diagnostics	191	274	0.113	240	311	0.128
Rehabilitation^b	16,174^c	17,625	0.173	12,338^d	21,109	0.008
Prescribed medication	1616	1772	0.008	1867	2028	0.114
LTOT^e	566	713	0.199	629	681	0.020
Subtotal healthcare costs	7302	8830	0.507	10,738	14,933	0.012
Costs outside healthcare sector
Impact daily activities participant	339	493	0.485	1153	963	0.553
Impact daily activities informal caregiver	49	27	0.280	23	204	0.001
Transportation	105	98	0.172	102	109	0.210
Over-the-counter medication	189	212	0.137	242	181	0.027
Subtotal costs outside healthcare sector	682	829	0.335	1520	1457	0.556
Total societal costs	7985	9660	0.441	12,258	16,390	0.059

Data are shown as mean (95% bootstrapped bias-corrected and accelerated confidence interval).

LTOT = long-term oxygen therapy.

^a Significant p-values are shown in bold.

^b Only considering participants that underwent rehabilitation.

^c Only one participant with low breathlessness burden was admitted to pulmonary rehabilitation in year 1, so no confidence interval could be calculated.

^d Some or all bootstrap sample results are missing, so no bootstrap estimation has been performed.

^e Only considering participants that used LTOT.

Figure 2. Healthcare costs per participant per year. BB: breathlessness burden; HCP: healthcare professional. *Significant difference.

Figure 3. Cost components of healthcare resource use. (a) Patients with low breathlessness burden in year 1. (b) Patients with low breathlessness burden in year 2. (c) Patients with high breathlessness burden in year 1. (d) Patients with high breathlessness burden in year 2. HCP: healthcare professional.

Table 4. Results of sensitivity analyses on total societal costs per participant per year (in Euro’s).

	Low breathlessness burden			High breathlessness burden
	N = 82 (46.1%)			N = 96 (53.9%)
	Year 1	Year 2	p-value^a	Year 1	Year 2	p-value^a
Base-case
Total societal costs	7985	9660	0.441	12,258	16,390	0.059
Highest medication prices
Total societal costs	9099	10,709	0.266	13,359	17,779	0.035
Impact on daily activities participant according to baseline employment status
Total societal costs	8422	10,144	0.487	12,536	16,735	0.052
Impact on daily activities informal caregiver excluded
Total societal costs	7936	9632	0.443	12,235	16,186	0.072
Combining all scenario’s with highest costs
Total societal costs	9536	11,193	0.347	13,637	18,124	0.030

Data are shown as mean (95% bootstrapped bias-corrected and accelerated confidence interval).

^a Significant p-values are shown in bold.