20-year trends in excess costs of COPD

Abstract

Background: Several major risk factors for COPD, such as population ageing, smoking rates and air pollution levels, are rapidly changing, causing inevitable changes in the population burden of COPD. We determined the excess direct costs of COPD and their trend from 2001 to 2020.

Methods: Using administrative health data from British Columbia, Canada, we created a retrospective matched cohort of physician-diagnosed COPD patients and non-COPD individuals. Excess direct medical costs (in 2020 Canadian dollars (CAD)) were estimated by analysing hospital records, outpatient services, medications and community care services. Comorbidity classes were assessed using International Classification of Diseases codes. Excess COPD costs were estimated as the adjusted difference in direct medical costs between the COPD and non-COPD cohorts.

Results: There were 208 554 and 404 703 individuals in the COPD and non-COPD cohorts, respectively (47.8% female; mean baseline age 69.1 and 68.2 years, respectively). Direct medical costs for COPD were CAD 9224 per patient-year compared to CAD 3396 per patient-year for non-COPD, giving rise to excess costs of CAD 5828 (95% CI 5759-5897) per patient-year. Excess costs increased by 48% over the study period. Excess costs due to comorbidities were CAD 3588 (95% CI 3554-3622) per patient-year, with cardiovascular-related conditions alone exceeding the costs attributed to COPD (CAD 1375 versus 904 per patient-year).

Conclusions: Despite multifaceted prevention and management initiatives, COPD-related economic burden is increasing, with the majority of costs due to comorbid conditions. Rising per-patient costs, combined with the flat or increasing prevalence of COPD in many jurisdictions, indicates a significant increase in COPD burden.

FIGURE 1

Estimated annual excess and direct medical costs in patients with COPD and direct medical costs in the non-COPD cohort during the 20-year study period. Data are presented as estimated costs with error bars indicating 95% confidence intervals. Excess COPD costs are the difference in direct medical costs between the COPD and non-COPD groups.

FIGURE 2

Estimated annual excess costs by cost component in patients with COPD and the non-COPD cohort during the 20-year study period. Data are presented as estimated costs with error bars indicating 95% confidence intervals.

FIGURE 3

Estimated excess costs in patients with COPD during the 20-year study period, segmented by comorbid conditions and cost components. Data are presented as estimated costs with error bars indicating 95% confidence intervals.