Resource Use and Costs up to Two Years Post Diagnosis Among Newly Diagnosed COPD Patients in the UK Primary Care Setting: A Retrospective Cohort Study

Figures & data

Table 1.  Unit costs estimated for the resource use categories

Resource use item	Unit cost	Reference
Moderate exacerbation	£85	NHS reference costs 2010–2011
Severe exacerbation	£1264	NHS reference costs 2010–2011
Hospital episode	£1367	PSSRU 2011
GP practice in-person visit	£36	PSSRU 2011, Page 149
GP practice nurse visit	£13	(Based on a 15.5 minute consultation) × £51 per hour of face-to-face contact
GP home visit	£121	PSSRU 2011, Page 149
GP out-of-office visit	£121	Assumed to be same as home visits
GP practice administrative contact	£22	PSSRU 2011, Page 149; considered equivalent to telephone consultation
GP practice correspondence	£3	Based on 30% of indirect contact of a 15.5 minute consultation (0.3 × 15.5) × £39 per hour of non-face-to-face contact

GP, general practitioner; NHS, National Health Service; PSSRU, Personal Social Services Research Unit.

Table 2.  Patient disposition and demographics

Patient variable, n (%)	All patients
All COPD	7881 (100)
Age, years, mean (SD)	67.15 (11)
Female	3546 (45)
Smoking status - current smoker	2991 (38)
Smoking status - former smoker	1170 (15)
BMI (m/kg2), mean (SD)	26.87 (6)
Co-morbid conditions	1366 (17)
Acute myocardial infarction	668 (8)
Congestive heart disease	475 (6)
Cerebrovascular disease	575 (7)
Depression	1064 (14)
Anxiety	1250 (16)
Asthma	2595 (33)
Cancer	1022 (13)
Diabetes	1047 (13)
Diabetes with complications	259 (3)
Disease severity (n = 7661)
Mild: FEV1 ≥ 80% predicted	1475 (19)
Moderate: 50% ≤ FEV1 < 80% predicted	4147 (54)
Severe: 30% ≤ FEV1 < 50% predicted	1754 (23)
Very Severe: FEV1 < 30% predicted	285 (4)
Level of dyspnoea (n = 6237)
MRC 1	1298 (21)
MRC 2	2602 (42)
MRC 3	1547 (25)
MRC 4	660 (11)
MRC 5	130 (2)

BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume at 1 second/forced vital capacity; MRC, Medical Research Council dyspnoea scale; SD, standard deviation.

Figure 1. Annual component and total COPD management costs before and during observation period..

Table 3.  Annual COPD management costs (excluding medication costs) by levels of airflow obstruction and dyspnoea for the 12- and 24-month periods post-diagnosis

	Patient categories	No. of patients	Cost per patient per year
			Exacerbations	Non-COPD hospitalisations	GP Visits	Total
12 months post-COPD diagnosis	Mild: FEV1 ≥80% predicted	1426	£191	£533	£1,238	£1,962
	Moderate: 50% ≤ FEV1 <80% predicted	4232	£191	£629	£1,193	£2,012
	Severe: 30% ≤ FEV1 <50% predicted	1732	£227	£656	£1,268	£2,151
	Very Severe: FEV1 <30% predicted	270	£260	£642	£1,355	£2,258
	MRC Grade 1	1298	£134	£424	£990	£1,548
	MRC Grade 2	2602	£164	£478	£1,100	£1,742
	MRC Grade 3	1547	£197	£601	£1,299	£2,097
	MRC Grade 4	660	£234	£670	£1,406	£2,310
	MRC Grade 5	130	£409	£1,381	£1,689	£3,478
24 months post-COPD diagnosis	Mild: FEV1 ≥80% predicted	1475	£177	£574	£1,170	£1,921
	Moderate: 50% ≤ FEV1 <80% predicted	4147	£192	£656	£1,198	£2,046
	Severe: 30% ≤ FEV1 <50% predicted	1754	£228	£642	£1,222	£2,092
	Very Severe: FEV1 <30% predicted	285	£313	£711	£1,268	£2,293
	MRC Grade 1	1298	£132	£410	£932	£1,473
	MRC Grade 2	2602	£166	£506	£1,119	£1,790
	MRC Grade 3	1547	£211	£642	£1,341	£2,195
	MRC Grade 4	660	£285	£765	£1,475	£2,526
	MRC Grade 5	130	£376	£1,230	£1,637	£3,243

COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume at 1 second/forced vital capacity; GP, general practitioner; MRC, Medical Research Council dyspnoea scale.

Table A1.  Annual rates of resource use among COPD patients in 24-months’ observation period

Annual rates per patient	Patient Variable
GP surgery visits	GP Out of office visits	GP administrative contacts	GP surgery correspondence	GP practice nurse visits	GP home visits	Moderate exacerbations	Severe exacerbations	Non-COPD hospitalisations
All COPD	12.85	0.15	27.99	1.24	4.92	0.26	0.51	0.13	0.47
Female	13.08	0.18	28.59	1.21	4.87	0.30	0.58	0.12	0.45
Age
Under 65	11.65	0.14	24.74	1.06	4.38	0.10	0.55	0.10	0.35
65 and over	13.71	0.16	30.34	1.37	5.32	0.38	0.48	0.14	0.56
Smoking Status
Current Smoker	12.18	0.15	26.75	1.15	4.76	0.23	0.50	0.13	0.47
Former Smoker	13.60	0.17	30.06	1.31	5.18	0.37	0.52	0.13	0.44
BMI
Underweight	11.84	0.24	28.66	1.20	5.17	0.38	0.54	0.18	0.49
Males	11.26	0.17	27.19	1.20	5.34	0.34	0.48	0.22	0.53
Females	12.18	0.28	29.53	1.20	5.07	0.40	0.57	0.15	0.47
Normal	12.27	0.14	26.38	1.12	4.77	0.26	0.50	0.12	0.47
Males	11.98	0.14	25.62	1.13	4.73	0.24	0.44	0.13	0.47
Females	12.58	0.15	27.21	1.11	4.82	0.28	0.57	0.12	0.46
Overweight	12.69	0.14	27.86	1.29	4.82	0.22	0.50	0.12	0.47
Males	12.61	0.12	27.44	1.33	4.92	0.22	0.45	0.13	0.49
Females	12.80	0.17	28.47	1.24	4.68	0.22	0.57	0.11	0.45
Obese	14.17	0.17	30.43	1.33	5.24	0.29	0.54	0.13	0.47
Males	13.96	0.14	30.34	1.36	5.33	0.24	0.46	0.12	0.50
Females	14.43	0.21	30.53	1.30	5.14	0.34	0.63	0.13	0.43
Airflow obstruction
Mild: FEV1 ≥80% predicted	12.99	0.11	27.03	1.10	4.95	0.21	0.45	0.11	0.42
Moderate: 50% ≤ FEV1 <80% predicted	13.00	0.15	27.84	1.23	4.94	0.25	0.47	0.12	0.48
Severe: 30% ≤ FEV1 <50% predicted	12.64	0.18	29.02	1.36	4.83	0.32	0.60	0.14	0.47
Very Severe: FEV1 <30% predicted	12.22	0.30	30.74	1.22	5.03	0.38	0.86	0.19	0.52
Level of dyspnoea
MRC 1	10.39	0.12	22.00	0.92	3.53	0.08	0.36	0.08	0.30
MRC 2	12.41	0.11	26.47	1.08	4.37	0.13	0.46	0.10	0.37
MRC 3	14.68	0.15	31.48	1.21	5.43	0.22	0.55	0.13	0.47
MRC 4	15.51	0.24	34.19	1.82	6.18	0.40	0.68	0.18	0.56
MRC 5	13.86	0.42	37.87	2.21	6.81	1.30	0.71	0.25	0.90

COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume at 1 second/forced vital capacity; GP, general practitioner; MRC, Medical Research Council dyspnoea scale.

Table A2.  Total annual COPD management costs (excluding medication costs) by levels of airflow obstruction and Medical Research Council (MRC) dyspnoea score for the 24-month periods post-diagnosis

	MRC Grade 1	MRC Grade 2	MRC Grade 3	MRC Grade 4	MRC Grade 5
Mild: FEV1 ≥ 80% predicted	£1,513	£1,788	£2,160	£2,928	£2,778
Moderate: 50% ≤ FEV1 < 80% predicted	£1,471	£1,827	£2,308	£2,512	£3,494
Severe: 30% ≤ FEV1 < 50% predicted	£1,469	£1,662	£2,041	£2,514	£3,492
Very Severe: FEV1 < 30% predicted	£1,590	£2,058	£2,090	£2,394	£2,334

COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume at 1 second.

Borg S, Ericsson A, Wedzicha J, et al. A computer simulation model of the natural history and economic impact of chronic obstructive pulmonary disease. Value Health 2004; 7(2):153–67.

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