Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun 27;9(6):e101228.
doi: 10.1371/journal.pone.0101228. eCollection 2014.

The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease: a cohort of hospitalized patients

Francesco Blasi  1 , Giancarlo Cesana  2 , Sara Conti  2 , Virginio Chiodini  2 , Stefano Aliberti  3 , Carla Fornari  2 , Lorenzo Giovanni Mantovani  4
Affiliations

The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease: a cohort of hospitalized patients

Francesco Blasi et al. PLoS One. .

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common disease with significant health and economic consequences. This study assesses the burden of COPD in the general population, and the influence of exacerbations (E-COPD) on disease progression and costs.

Methods: This is a secondary data analysis of healthcare administrative databases of the region of Lombardy, in northern Italy. The study included ≥ 40 year-old patients hospitalized for a severe E-COPD (index event) during 2006. Patients were classified in relation to the number and type of E-COPD experienced in a three-year pre-index period. Subjects were followed up until December 31st, 2009, collecting data on healthcare resource use and vital status.

Results: 15857 patients were enrolled -9911 males, mean age: 76 years (SD 10). Over a mean follow-up time of 2.4 years (1.36), 81% of patients had at least one E-COPD with an annual rate of 3.2 exacerbations per person-year and an all-cause mortality of 47%. A history of exacerbation influenced the occurrence of new E-COPD and mortality after discharge for an E-COPD. On average, the healthcare system spent 6725€ per year per person (95%CI 6590-6863). Occurrence and type of exacerbations drove the direct healthcare cost. Less than one quarter of patients presented claims for pulmonary function tests.

Conclusions: COPD imposes a substantial burden on healthcare systems, mainly attributable to the type and occurrence of E-COPD, or in other words, to the exacerbator phenotypes. A more tailored approach to the management of COPD patients is required.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: FB reports receiving consulting fees from Bayer, Pfizer, Nycomed, Zambon, and GlaxoSmithKline; lecture fees from Bayer, Pfizer, Nycomed, Zambon, Novartis and Chiesi; and grant support from Nycomed, Zambon, Chiesi. CF reports receiving travel and accommodation expenses from Nycomed. SA received travel and accommodation expenses, as well as fees for congress presentations from Nycomed, Zambon, Pfizer, Boehringer-Ingelheim and Menarini. LGM reports receiving consulting fees from Novartis, and GlaxoSmithKline; research grants from Airliquide. All other members declare that they have no conflicts of interest. Finally the study was funded by Nycomed-Takeda SpA. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Probability of survival during follow-up in relation to the three study groups.
Group A: patients with at least one severe exacerbation of chronic obstructive pulmonary disease (E-COPD) in the three-year pre-index period; Group B: patients with only moderate E-COPD in the three-year pre-index period; Group C patients without E-COPD in the three-year pre-index period. Differences between groups are significant (p<0.05, Log-rank and Wilcoxon tests).
Figure 2
Figure 2. Probability of having an E-COPD during follow-up in relation to the three study groups.
Group A: patients with at least one severe exacerbation of chronic obstructive pulmonary disease (E-COPD) in the three-year pre-index period; Group B: patients with only moderate E-COPD in the three-year pre-index period; Group C patients without E-COPD in the three-year pre-index period. Differences between groups are significant (p<0.05, Log-rank and Wilcoxon tests).
Figure 3
Figure 3. Hazard Ratio of death (HR, 95%CI) by number (N) and type of E-COPD experienced during follow-up.
Time-dependent Cox model adjusted by age, sex, comorbidities (Charlson index) and history of E-COPD in the three-year pre-index period.
See this image and copyright information in PMC

References

    1. (2007) Global surveillance, prevention and control of chronic respiratory disease. A comprehensive approach. In: Press W, editor. WHO Library Cataloguing. Switzerland: WHO.
    1. Mathers CD, Loncar D (2006) Projections of Global Mortality and Burden of Disease from 2002 to 2030. Plos Medicine 3: e442–e461. - PMC - PubMed
    1. (2008) World Health Statistics 2008. WHO.
    1. Cazzola M, MacNee W, Martinez FJ, Rabe KF, Franciosi LG, et al. (2008) Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J 31: 416–469. - PubMed
    1. Mapel DW, Roberts MH (2012) New Clinical Insights into Chronic Obstructive Pulmonary Disease and Their Implications for Pharmacoeconomic Analyses. Pharmacoeconomics 30: 869–885. - PMC - PubMed

Publication types

MeSH terms