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Observational Study
. 2017 Dec 4:12:3437-3448.
doi: 10.2147/COPD.S141852. eCollection 2017.

The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort

Margarethe E Wacker  1 , Katharina Kitzing  1   2 , Rudolf A Jörres  3 , Reiner Leidl  1   4 , Holger Schulz  5 , Stefan Karrasch  3   5 , Annika Karch  6 , Armin Koch  6 , Claus F Vogelmeier  7 , Rolf Holle  1
Affiliations
Observational Study

The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort

Margarethe E Wacker et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Although patients with COPD often have various comorbidities and symptoms, limited data are available on the contribution of these aspects to health care costs. This study analyzes the association of frequent comorbidities and common symptoms with the annual direct and indirect costs of patients with COPD.

Methods: Self-reported information on 33 potential comorbidities and symptoms (dyspnea, cough, and sputum) of 2,139 participants from the baseline examination of the German COPD cohort COSYCONET was used. Direct and indirect costs were calculated based on self-reported health care utilization, work absence, and retirement. The association of comorbidities, symptoms, and COPD stage with annual direct/indirect costs was assessed by generalized linear regression models. Additional models analyzed possible interactions between COPD stage, the number of comorbidities, and dyspnea.

Results: Unadjusted mean annual direct costs were €7,263 per patient. Other than COPD stage, a high level of dyspnea showed the strongest driving effect on direct costs (+33%). Among the comorbidities, osteoporosis (+38%), psychiatric disorders (+36%), heart disease (+25%), cancer (+24%), and sleep apnea (+21%) were associated with the largest increase in direct costs (p<0.01). A sub-additive interaction between advanced COPD stage and a high number of comorbidities reduced the independent cost-driving effects of these factors. For indirect costs, besides dyspnea (+34%), only psychiatric disorders (+32%) and age (+62% per 10 years) were identified as significant drivers of costs (p<0.04). In the subsequent interaction analysis, a high number of comorbidities was found to be a more crucial factor for increased indirect costs than single comorbidities.

Conclusion: Detailed knowledge about comorbidities in COPD is useful not only for clinical purposes but also to identify relevant cost factors and their interactions and to establish a ranking of major cost drivers. This could help in focusing therapeutic efforts on both clinically and economically important comorbidities in COPD.

Keywords: COPD; comorbidities; direct and indirect costs; health care; symptoms.

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Conflict of interest statement

Disclosure CV reports personal fees from the pharmaceutical companies Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Janssen, Mundipharma, Novartis, Takeda, and Cipla, and grants and personal fees from Grifols outside the submitted work. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Lifetime prevalence (%) of comorbid conditions. Notes: aHeart disease: including cardiac arrhythmia, cardiac insufficiency, narrow coronary vessel, and angina pectoris. bPsychiatric disorder: including anxiety, depression, and psychosis. cMental deficiency: including weakness of memory, restlessness, disorientation, and confusion. dOther lung disease: fibrosis, sarcoidosis, and bronchiectasis.
Figure 2
Figure 2
Adjusted mean total direct or indirect costs (€) per year for subgroups. Note: Means were adjusted according to regression models shown in Table 4. Abbreviations: GOLD, Global initiative for Obstructive Lung Disease; mMRC, modified Medical Research Council.
See this image and copyright information in PMC

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