M. Friedman et De. Hilleman, Economic burden of chronic obstructive pulmonary disease - Impact of new treatment options, PHARMACOECO, 19(3), 2001, pp. 245-254
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.