A Systematic Literature Review of the Humanistic, Economic, Sociodemographic, and Environmental Burden Associated with Severe COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a highly prevalent and progressive disease, hence greater understanding of its humanistic, economic, and environmental impact is essential for guiding effective management strategies. A systematic literature review (SLR; 2021-2023), complemented with a targeted literature review (TLR; 2013-2023) identified 2039 publications on the economic and humanistic burden of severe COPD. Additionally, an SLR and complementary TLR to evaluate the impact of environmental and sociodemographic factors on COPD (2013-2023), identified 1018 records. All searches were conducted on November 17, 2023. After applying prespecified selection criteria, 50 studies reporting on the humanistic and economic impact of COPD, and six studies on the environmental and sociodemographic impact, were selected. Severe COPD significantly impairs health-related quality of life, exerting effects on physical and psychological well-being, with a progressive decline as COPD worsens from mild to very severe. Evidence indicates that there is a significant burden of disease due to exacerbations of COPD, with their frequency and severity increasing with disease progression, and an increased mortality risk associated with very severe versus severe COPD. The studies reported a high frequency of healthcare resource utilization, including primary care visits, emergency department visits, and hospitalizations among patients with severe COPD, all of which contribute to a significant economic burden, particularly in patients with advanced disease. Environmental factors demonstrated diverse impacts on outcomes for individuals with severe COPD, varying by type of pollutant, disease severity, and patient characteristics. Studies examining the sociodemographic impact of underserved populations on the burden of severe COPD were not identified. Severe COPD is a multifaceted disease that imposes considerable humanistic and economic impact on both patients and healthcare systems. Further work is needed to understand the impact of environmental and sociodemographic factors on the burden of COPD, with such insights ultimately optimizing patient care.

Keywords: COPD; costs; environmental impact; healthcare resource utilization; quality of life.

Figure 1

PRISMA flow diagram for humanistic and economic burden (A) and environmental and sociodemographic impact (B).

Figure 2

Continued.

Figure 2

Patient-level direct healthcare costs in Germany (A), Spain (B), and China (C), and COPD-related direct healthcare costs in the US according to FEV1% predicted (D), and GOLD stage (E).