Economic burden of chronic obstructive pulmonary disease - Impact of new treatment options

The incidence, morbidity and mortality of chronic obstructive pulmonary dis ease (COPD) is rising throughout the world. The total economic cost of COPD in the US in 1993 was estimated to be over $US 15.5 billion, with $US6.1 b illion for hospitalisation, $US4.4 billion for physician and other fees. $U S2.5 billion for drugs, $US 1.5 billion for nursing home care and $US 1.0 b illion for home care. Office visits, hospital outpatient visits and emergen cy department visits accounted for 17.3% of the direct costs for COPD in th e US. When stratified by severity, COPD treatment costs strongly correlate with disease severity. The American Thoracic Society, the European Respirat ory Society and the British Thoracic Society have developed guidelines for the pharmacological treatment of COPD. However, the guidelines establish in haled bronchodilators( anticholinergic agents and beta (2)-adrenergic agoni sts) as the mainstay of therapy for patients with COPD. The guidelines were not based on cost analyses and thus: are not a priori cost-effective guide lines. Since the publication of these guidelines, several new pharmacological prod ucts have been approved for use in patients with COPD including a combinati on of an anticholinergic and selective beta (2)-adrenergic agonist [ ipratr opium/salbutamol (albuterol)] and a long-acting beta (2)-adrenergic agonist (salmeterol). Both products are effective bronchodilators in COPD. The pur pose of this report is to place these new agents in an updated pharmacologi cal guideline scheme, utilising recently published data on clinical efficac y as well as pharmacoeconomics. The annualised healthcare costs were comput ed to be $US788/patient/year for the combination ipratropium/salbutamol inh aler and $US 1059/patient/year for salmeterol(1999 values). Based upon an i mproved understanding of the complexity of COPD, the response of patients t o newer bronchodilators (given individually or in combination), and recent pharmacoeconomic data for COPD treatment, a new treatment algorithm with as sociated costs is proposed. The use of an algorithm, based on medical and p harmacoeconomic data, will improve lung function in patients with COPD, imp rove patient satisfaction (e.g. quality of life, dyspnoea) and outcomes (e. g. exacerbations). It will also result in a positive effect on healthcare c osts.