Direct medical costs of chronic obstructive pulmonary disease: chronic bronchitis and emphysema

In this study we aimed to estimate direct medical costs of Chronic Obstruct ive Pulmonary Disease (COPD) by disease type: chronic bronchitis and emphys ema. This study estimates direct costs in 1996 dollars using a prevalence approa ch and both aggregate and micro-costing. A societal perspective is taken using prevalence, and multiple national, st ate and local data sources are used to estimate health-care utilization and costs. Chronic bronchitis and emphysema together account for $14.5 billion in annu al direct costs. Inpatient costs are greater than outpatient and emergency costs ($8.3 vs. $7.8 billion) and hospital and medication costs account for most resources spent. The high prevalence of chronic bronchitis accounts f or its larger total costs ($11.7 billion) compared with emphysema ($2.8 bil lion). Emphysema, which is more severe, has higher costs per prevalent case ($1341 vs. $816). Hospital stays account for the highest costs, $6.0 billi on for chronic bronchitis and $1.9 billion for emphysema. The hospitalizati on rate, length of stay and average cost per prevalent case are higher for emphysema than for chronic bronchitis. Medication costs are the second high est cost category ($4.4 billion for chronic bronchitis, $0.693 billion for emphysema). The high hospitalization and low home care costs (0.2% of total) suggest un deruse of home care and room to shift from acute to preventive carl. More a ttention to healthcare management of chronic bronchitis and emphysema is su ggested, and improving inhaler and anti-smoking compliance might be importa nt targets.