Supplementary Table 4 The economic burden of symptomatic COPD representing health care resource use, treatment/medication costs, exacerbation costs, laboratory costs and other costs
HEALTH CARE RESOURCE USEStudy name / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Total cost / Mean (SD)
Confronting COPD Survey: Global (Wouters 2003)*[38] / Overall COPD / France / Euros / PCP visits: Scheduled visits / 400 / 66
PCP visits: Unscheduled visits / 400 / 19
Specialist visits: Scheduled visits / 400 / 16
Specialist visits: Unscheduled visits / 400 / 11
Inpatient hospitalisations / 400 / 118
ER visits / 400 / 3
Canada / CAD$ / PCP visits: Scheduled visits / 401 / 110.57
PCP visits: Unscheduled visits / 401 / 12.83
Specialist visits: Scheduled visits / 401 / 61.68
Specialist visits: Unscheduled visits / 401 / 8.16
Inpatient hospitalisations / 401 / 1049
ER visits / 401 / 92.34
USA / USD / PCP visits: Scheduled visits / 447 / 203.99 (415.78)
PCP visits: Unscheduled visits / 447 / 18.48 (56.92)
Specialist visits: Scheduled visits / 447 / 127.79 (264.92)
Specialist visits: Unscheduled visits / 447 / 18.44 (77.14)
Inpatient hospitalisations / 447 / 2891 (13,697)
ER visits / 447 / 289.1 (1002.8)
Italy / Euros / Unscheduled care: Inpatient hospitalisation / 400 / 963.1
Unscheduled care: ER visits / 400 / 5.92
Unscheduled care: PCP visits / 400 / 1.87
Unscheduled care: Specialist visits / 400 / 4.07
Scheduled care: PCP visits / 400 / 42
Scheduled care: Specialist visits / 400 / 23.63
The Netherlands / 2002 / Euros / PCP visits: Scheduled visits / 415 / 33.9
PCP visits: Unscheduled visits / 8.69
Specialist visits: Scheduled visits / 415 / 65.06
Specialist visits: Unscheduled visits / 13.73
Inpatient hospitalisation / 415 / 68.52
ER visit / 415 / 41.27
PCP visits: Scheduled visits / 402 / 57.34
PCP visits: Unscheduled visits / 402 / 2.63
Specialist visits: Scheduled visits / 402 / 109.01
Specialist visits: Unscheduled visits / 402 / 18.21
Inpatient hospitalisations / 402 / 2708
ER visits / 402 / 74.18
UK / Pounds (Euros) / Unscheduled care: Inpatient hospitalisation / 400 / 444.60 (689.10)a
Unscheduled care: Hospital emergency and accident department (AE visits) / 400 / 18.05 (27.98)a
Unscheduled care: GP visits / 400 / 12.67 (19.64)a
Unscheduled care: Specialist visits / 400 / 19.35 (29.98)a
Scheduled care: GP visits / 400 / 92.87 (143.94)a
Scheduled care: Specialist visits / 400 / 41.43 (64.21)a
Study name / Type of COPD / Study group(s) / Resource use item / Units/Timeframe / N / Total resource / Mean (SD)
CONSULTATIONS
BREATHE Study (Polatli 2012)*[37] / Overall COPD / Algeria / Consultations / No. of consultations / 313,997 / 301,437 / -
Egypt / 632,655 / 1,353,079 / -
Jordan / 49,607 / 61,728 / -
Lebanon / 67,142 / 144,170 / -
Morocco / 172,088 / 281,599 / -
Pakistan / 693,000 / 4,276,800 / -
Saudi Arabia / 122,014 / 293,606 / -
Syria / 212,075 / 313,595 / -
Tunisia / 105,834 / 246,279 / -
Turkey / 987,498 / 2,071,129 / -
UAE / 15,917 / 43,118 / -
Confronting COPD Survey (Wouters 2003)*[38] / Overall COPD / France / PCP visits: Scheduled / Per patient / 400 / 1514 / 3.79 (7.81)
PCP visits: Unscheduled / 400 / 423 / 1.06 (3.92)
Canada / PCP visits: Scheduled / 401 / 1506 / 3.79 (7.2)
PCP visits: Unscheduled / 401 / 175 / 0.44 (1.52)
USA / PCP visits: Scheduled / 447 / 2026 / 4.55 (9.26)
PCP visits: Unscheduled / 447 / 184 / 0.41 (1.26)
Italy / PCP visits: Scheduled / 400 / 1301 / 3.25 (8.61)
PCP visits: Unscheduled / 400 / 58 / 0.15 (0.76)
Spain / PCP visits: Scheduled / 402 / 2045 / 5.1 (11.44)
PCP visits: Unscheduled / 402 / 94 / 0.23 (1.34)
The Netherlands / PCP visits: Scheduled / 415 / 848 / 2.04 (5.71)
PCP visits: Unscheduled / 415 / 217 / 0.52 (4.76)
UK / PCP visits: Scheduled / 400 / 2322 / 5.8 (9.83)
PCP visits: Unscheduled / 400 / 317 / 0.79 (0.79)
Overall COPD / France / Specialist visits: Scheduled / Per patient / 400 / 275 / 0.69 (2.21)
Specialist visits: Unscheduled / 400 / 106 / 0.27 (2.12)
Canada / Specialist visits: Scheduled / 401 / 295 / 0.74 (2.24)
Specialist visits: Unscheduled / 401 / 106 / 0.27 (2.12)
USA / Specialist visits: Scheduled / 447 / 672 / 1.51 (3.12)
Specialist visits: Unscheduled / 447 / 106 / 0.27 (2.12)
Italy / Unscheduled care: Specialist visits / 400 / 106 / 0.27 (2.12)
Scheduled care: Specialist visits / 400 / 458 / 1.14 (2.83)
The Netherlands / Total scheduled specialist visit / Per patient per year / 415 / 596 / 1.44 (2.78)
Total unscheduled specialist visit / 415 / 106 / 0.27 (2.12)
Spain / Specialist visits: Scheduled / Per patient / 402 / 444 / 1.11 (2.59)
Specialist visits: Unscheduled / 402 / 106 / 0.27 (2.12)
UK / Unscheduled care: Specialist visits / 400 / 106 / 0.27 (2.12)
Scheduled care: Specialist visits / 400 / 227 / 0.57 (2.07)
BREATHE Study (Polatli 2012)*[37] / Mild, moderate, and severe / Algeria / Physician consultation / No. of consultations / 56 / - / 1.8 (SE: 1.1)
Egypt / 84 / - / 4.4 (SE: 4.1)
Jordan / 86 / - / 2 (SE: 1.6)
Lebanon / 72 / - / 3.3 (SE: 2.8)
Morocco / 42 / - / 3 (SE: 3.6)
Pakistan / 27 / - / 6.9 (SE: 5.4)
Saudi Arabia / 141 / - / 3.7 (SE: 3.7)
Syria / 59 / - / 2.9 (SE: 3.4)
Tunisia / 37 / - / 3.3 (SE: 6.3)
Turkey / 232 / - / 3.1 (SE: 3)
UAE / 16 / - / 4.6 (SE: 4.9)
Total / 852 / - / 3.4 (SE: 3.6)
CAT score <10 / 233 / - / 3.11 (2.77)
CAT score ≥10 / 781 / - / 3.22 (3.47)
Overall total with both CAT score / 1014 / - / 3.2 (3.37)
No comorbidities / 413 / - / 3.67 (4.03)
Any comorbidity / 439 / - / 3.15 (3.12)
Diabetes / 160 / - / 2.98 (2.8)
Cardiovascular comorbidity / 218 / - / 3.05 (3)
HOSPITALISATIONS
BREATHE Study (Polatli 2012)*[37] / Overall COPD / Algeria / Hospitalisations / No. of hospitalisation / 313,997 / 74,761 / -
Egypt / 632,655 / 219,612 / -
Jordan / 49,607 / 10,630 / -
Lebanon / 67,142 / 26,010 / -
Morocco / 172,088 / 89,396 / -
Pakistan / 693,000 / 462,000 / -
Saudi Arabia / 122,014 / 103,842 / -
Syria / 212,075 / 70,692 / -
Tunisia / 105,834 / 63,899 / -
Turkey / 987,498 / 476,674 / -
UAE / 15,917 / 15,563 / -
Algeria / No. of nights hospitalised / 313,997 / 328,949 / -
Egypt / 632,655 / 446.796 / -
Jordan / 49,607 / 47836 / -
Lebanon / 67,142 / 122,186 / -
Morocco / 172,088 / 221,008 / -
Pakistan / 693,000 / 1,270,500 / -
Saudi Arabia / 122,014 / 126,341 / -
Syria / 212,075 / 269,745 / -
Tunisia / 105,834 / 87,862 / -
Turkey / 987,498 / 1,695,597 / -
UAE / 15,917 / 24,641 / -
Confronting COPD Survey (Wouters 2003)*[38] / Overall COPD / France / Inpatient hospitalisations / Per patient / 400 / 135 / 0.34 (1.79)
Canada / Inpatient hospitalisations / 401 / 128 / 0.32 (1.12)
USA / Inpatient hospitalisations / 447 / 168 / 0.38 (1.78)
Italy / Unscheduled care: Inpatient hospitalisation / 400 / 134 / 0.33 (2.16)
The Netherlands / Total inpatient hospitalisations / Per patient per year / 415 / 114 / 0.27 (1.65)
Spain / Inpatient hospitalisations / Per patient / 402 / 403 / 1 (5.28)
UK / Unscheduled care: Inpatient hospitalisation / 400 / 171 / 0.43 (1.82)
BREATHE Study (Polatli 2012)*[37] / Mild, moderate, and severe / CAT score <10 / Hospitalisation / No. of hospitalisation / 233 / - / 0.74 (0.96)
CAT score ≥10 / 781 / - / 2.72 (4.36)
Overall total with both CAT score / 1014 / - / 2.46 (4.13)
No comorbidities / 100 / - / 2.03 (2.57)
Any comorbidity / 184 / - / 2.45 (4.07)
Diabetes / 66 / - / 2.54 (5.57)
Cardiovascular comorbidity / 87 / - / 2.01 (3.9)
Algeria / Hospitalisation (overnight or longer) / 11 / - / 2.3 (SE: 2.6)
Egypt / 35 / - / 1.7 (SE: 3.1)
Jordan / 29 / - / 1 (SE: 1.4)
Lebanon / 32 / - / 1.3 (SE: 1.5)
Morocco / 10 / - / 4 (SE: 4.8)
Pakistan / 10 / - / 2 (SE: 1.8)
Saudi Arabia / 48 / - / 3.8 (SE: 6.3)
Syria / 25 / - / 1.5 (SE: 1.4)
Tunisia / 6 / - / 5.3 (SE: 4.8)
Turkey / 67 / - / 2.5 (SE: 2.4)
UAE / 11 / - / 2.4 (SE: 1.6)
Total / 284 / - / 2.3 (SE: 3.7)
Algeria / Nights of hospitalisation / No. of nights hospitalised / - / - / 10 (SE: 8.2)
Egypt / - / - / 3.5 (SE: 5.4)
Jordan / - / - / 4.7 (SE: 7.5)
Lebanon / - / - / 6.3 (SE: 11)
Morocco / - / - / 9.9 SE: 11.1)
Pakistan / - / - / 5.5 (SE: 6.4)
Saudi Arabia / - / - / 4.7 (SE: 7.9)
Syria / - / - / 5.8 (SE: 12.3)
Tunisia / - / - / 7.3 (SE: 3.9)
Turkey / - / - / 8.9 (SE: 8.2)
UAE / - / - / 3.8 (SE: 5)
Total / - / - / 5.8 (SE: 8.7)
No comorbidities / - / - / 5.07 (7.75)
Any comorbidity / - / - / 6.15 (9.05)
Diabetes / - / - / 7.33 (11.83)
Cardiovascular comorbidity / - / - / 7.08 (11.21)
EMERGENCY VISITS
BREATHE Study (Polatli 2012)*[37] / Overall COPD / Algeria / Emergency visits / No. of visits / 313,997 / 116,627 / -
Egypt / 632,655 / 253,798 / -
Jordan / 49,607 / 41,103 / -
Lebanon / 67,142 / 36,293 / -
Morocco / 172,088 / 17,879 / -
Pakistan / 693,000 / 300,300 / -
Saudi Arabia / 122,014 / 145,193 / -
Syria / 212,075 / 57,670 / -
Tunisia / 105,834 / 27,956 / -
Turkey / 987,498 / 683,697 / -
UAE / 15,917 / 15,917 / -
Confronting COPD Survey (Wouters 2003)*[38] / Overall COPD / France / Emergency visits / Per patient / 400 / 59 / 0.15 (0.55)
Canada / 401 / 151 / 0.38 (1.22)
USA / 447 / 233 / 0.52 (1.81)
Italy / Unscheduled care: Emergency visits / 400 / 38 / 0.1 (0.41)
The Netherlands / Total Emergency visits / 415 / 189 / 0.45 (5.6)
Spain / Emergency visits / 402 / 312 / 0.78 (3.03)
BREATHE Study (Polatli 2012)*[37] / Mild, moderate, and severe / Algeria / Emergency visits / No. of visits / 11 / - / 3.5 (SE: 2.6)
Egypt / 23 / - / 3 (SE: 3)
Jordan / 22 / - / 5.3 (SE: 12)
Lebanon / 23 / - / 2.6 (SE: 4)
Morocco / 3 / - / 2.7 (SE: 2.1)
Pakistan / 8 / - / 1.6 (SE: 0.9)
Saudi Arabia / 64 / - / 4 (SE: 4.4)
Syria / 13 / - / 2.4 (SE: 1.38)
Tunisia / 2 / - / 7 (SE: 7.1)
Turkey / 74 / - / 3.25 (SE: 3.8)
UAE / 6 / - / 4.5 (SE: 5.1)
Total / 249 / - / 3.5 (SE: 5.1)
CAT score <10 / 233 / - / 1.87 (1.46)
CAT score ≥10 / 781 / - / 3.96 (6.02)
Overall total with both CAT score / 1014 / - / 3.78 (5.79)
No comorbidities / 107 / - / 3.05 (6.2)
Any comorbidity / 142 / - / 3.85 (4.02)
Diabetes / 56 / - / 3.6 (4)
Cardiovascular comorbidity / 66 / - / 3.92 (4.42)
HOSPITAL ADMISSION COST
Punekar 2013 [52] / Overall COPD / MRC Grade 1; 12 months post-COPD diagnosis / 2010-11 / Euros / Non-COPD hospitalisation cost / 1391 / - / 399.82
MRC Grade 2; 12 months post-COPD diagnosis / 2010-11 / 2534 / - / 464.21
MRC Grade 3; 12 months post-COPD diagnosis / 2010-11 / 1448 / - / 628.74
MRC Grade 4; 12 months post-COPD diagnosis / 2010-11 / 603 / - / 647.59
MRC Grade 5; 12 months post-COPD diagnosis / 2010-11 / 108 / - / 1301.79
MRC Grade 1; 24 months post-COPD diagnosis / 2010-11 / 1298 / - / 891.07
MRC Grade 2; 24 months post-COPD diagnosis / 2010-11 / 2602 / - / 996.32
MRC Grade 3; 24 months post-COPD diagnosis / 2010-11 / 1547 / - / 1253.8
MRC Grade 4; 24 months post-COPD diagnosis / 2010-11 / 660 / - / 1476.36
MRC Grade 5; 24 months post-COPD diagnosis / 2010-11 / 130 / - / 2745.2
OUTPATIENT/GP VISIT COST
Punekar 2013 [52] / Overall COPD / MRC Grade 1; 12 months post-COPD diagnosis / 2010-11 / £ / GP visit costs / 1391 / - / 1445.96
MRC Grade 2; 12 months post-COPD diagnosis / 2534 / - / 1531.08
MRC Grade 3; 12 months post-COPD diagnosis / 1448 / - / 1740.28
MRC Grade 4; 12 months post-COPD diagnosis / 603 / - / 1821.86
MRC Grade 5; 12 months post-COPD diagnosis / 108 / - / 2299.16
MRC Grade 1; 24 months post-COPD diagnosis / 1298 / - / 2457.57
MRC Grade 2; 24 months post-COPD diagnosis / 2602 / - / 2613.56
MRC Grade 3; 24 months post-COPD diagnosis / 1547 / - / 3026.68
MRC Grade 4; 24 months post-COPD diagnosis / 660 / - / 3336.49
MRC Grade 5; 24 months post-COPD diagnosis / 130 / - / 3701.74
Sridhar 2008 [122] / Overall COPD / COPD treated with intervention / NR / Sterling Pound (£) / Cost of GP consultations (171 contacts) / 61 / 5301 / -
COPD treated with control / Sterling Pound (£) / Cost of GP consultations (280 contacts) / 61 / 8680 / -
Study name / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Total cost / Mean (SD) / Median [range] (95% CI)
Sridhar 2008 [122] / Overall COPD / COPD treated with intervention / NR / Sterling Pound (£) / Travel costs for home visits / 61 / £37.21 / - / -
COPD treated with control / 61 / £0 / - / -
HOSPITAL STAY
Bakerly 2009 [79] / AECOPD / Retrospective arm (conventional treatment) / Inpatient LOS / In days / 95 / 10.4 (7.7) / -
130 / 3.3 (3.9) / -
2-month readmission / 95 / 0.48 / -
130 / 0.42 / -
Average no. of home visits per patient for ACAS-supported patients / Home visits / - / 3.08 (0.95) / (95% CI: 2.9, 3.2)
George 2011* [96] / Exacerbation COPD / Summary of results at patient level: 2003 / LOS from admission to discharge / Days / - / - / 6 [IQR: 3, 10]
Summary of results at patient level: 2008 / - / - / 5 [IQR: 3, 10]
Summary of results aggregated at unit level, expressed as median percentage unit result and (IQR of unit results): 2003 / - / - / 6 [IQR: 5, 8]
Summary of results aggregated at unit level, expressed as median percentage unit result and (IQR of unit results): 2008 / - / - / 6 [IQR: 4, 7]
COPD audit 2003 / Annual no. of admissions per unit / Admissions / - / 606 / 486 [IQR: 331, 716]
COPD audit 2008 / - / 673 / 486 [IQR: 363, 792]
Sridhar 2008 [122] / Overall COPD / Intervention / No. of admissions per patient / Admissions / 55 / - / 0 [range: 0, 13]
Control / 49 / - / 0 [range: 0, 5]
Study name / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Mean (SD) / Median [range]
HOSPITAL ADMISSION COST
Dal Negro 2011 [56] / Overall COPD / Period 2001-2003 / NR / USD / Cost due to hospital admissions / 513 / 204.5 (56.6) / -
Period 2004-2006 / Cost due to hospital admissions / 421 / 167.7 (42.8) / -
Vitacca 2009 [128] / Overall COPD / TA program / NR / € / Hospitalisations in respiratory ward / 5754 (6415) / -
TA program / Hospitalisation in ICU / - / 3842 (15082) / -
Usual outpatient follow-up regimen / Hospitalisations in respiratory ward / - / 8727 (9221) / -
Usual outpatient follow-up regimen / Hospitalisation in ICU / - / 15 365 (31897) / -
HOME CARE COST
Vitacca 2009 [128] / Overall COPD / TA program / NR / € / Home nurse visits / - / 108 (282) / -
Usual outpatient follow-up regimen / - / 82 (253) / -
EMERGENCY ROOM ADMISSIONS COST
Vitacca 2009 [128] / Overall COPD / TA program / NR / € / ER admissions / - / 39 (63) / -
Usual outpatient follow-up regimen / - / 80 (105) / -
OUTPATIENT/GP VISIT COST
Vitacca 2009 [128] / Overall COPD / TA program / NR / € / Outpatient visit / - / 6 (14) / -
Urgent GP visit / - / 23 (51) / -
Usual outpatient follow-up regimen / Outpatient visit / - / 98 (41) / -
Urgent GP visit / - / 72 (110) / -
Study name / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Mean (SD) / Median [range]
Vitacca 2009 [128] / Overall COPD / TA program / NR / Euros / Transportation / - / 1.2 (3.2) / -
Usual outpatient follow-up regimen / Transportation / - / 21 (7) / -
Study name / Type of COPD / Study group(s) / Resource use item / Units/Timeframe / N / Mean (SD) / Median [range]
HOSPITAL STAY
Bertolini 2005 [81] / Overall COPD / Before restriction and standardisation (ICU) / Length of ICU stay / Days / 84 / - / 8 [70]
Before restriction and standardisation (RICU) / 80 / - / 8.5 [40]
After restriction and standardisation (ICU) / 60 / - / 7 [70]
After restriction and standardisation (RICU) / 65 / - / 8 [40]
Before restriction and standardisation (ICU) / Length of hospital stay / Days / 84 / - / 17 [89]
Before restriction and standardisation (RICU) / 80 / - / 15 [160]
After restriction and standardisation (ICU) / 60 / - / 16 [89]
After restriction and standardisation (RICU) / 65 / - / 13 [39]
Alive (RICU) / Length of stay / Days / - / - / 8 [range: 4, 12]
Dead (RICU) / - / - / 4 [range: 2, 10]
Alive (ICU) / - / - / 7 [range: 4, 15]
Dead (ICU) / - / - / 9 [range: 6, 51]
Ricauda 2008 [60] / Overall COPD / Geriatric Home Hospitalisation service (GHHS) / Length of stay / Days / 52 / 15.5 (9.5) / -
General medical ward (GMW) / 52 / 11 (7.9) / -
Geriatric Home Hospitalisation service (GHHS) / Readmission rate after 6 months / Per patient / - / 0.4 (0.6) / -
General medical ward (GMW) / - / 1.1 (1.2) / -
Romagnoli 2006 [115] / Overall COPD / Group 1 / Hospital admissions / Per patient per year / 14 / 1 (0.8) / -
Group 2 / 15 / 1.5 (1.1) / -
Group 1 / Hospitalisation days / Per patient per year / 14 / 14 9) / -
Group 2 / 15 / 9 (8) / -
Vitacca 2009 [128] / Overall COPD / Tele-assistance program / Hospital admissions / Days / - / 0.17 (0.23) / -
Usual outpatient follow-up regimen / Per month / - / 0.3 (0.3) / -
HOSPITAL VISITS
Dal Negro2011 [56] / Overall COPD / Period 2001-2003 / No. of visits / Mean no./visit / - / 4.7 / -
Period 2004-2006 / - / 3.5 / -
Study name / Country / Type of COPD / Study group(s) / Resource use item / Units/Timeframe / N / Total resource / Mean (SD) / Median
HOSPITAL STAY
Andreassen 2011 [76] / Sweden, Norway / Overall COPD / Overall COPD: Patients with CAP / LOS / Days / - / - / - / 9
Overall COPD: Patients without CAP / - / - / - / 5
Wang 2010 [129] / Norway / Overall COPD / Group A: Patients admitted to the pulmonary department / Readmission rate / Readmissions / 68 / - / 0.93 (1.38) / -
Group B: Patients admitted to internal medical departments / 77 / - / 1.17 (1.94) / -
Study name / Country / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Total cost / Mean (SD) / Median (range)
HOSPITAL STAY
Simoens 2007 [121] / Belgium / Overall COPD / Overall COPD / 2005 / Euros / Hospital stay / 267 / - / - / 4069 (904, 24,412)
Fluoroquinoles / - / - / - / 4521 (1356, 17,631)
Other antibiotics / - / - / - / 4069 (904, 24,412)
GOLD stage IV / Intensive care cost / 35 / 42,068 / - / -
Overall COPD / 142 / 42,068 / - / -
Study name / Country / Type of COPD / Study group(s) / Resource use item / Units/Timeframe / N / Total resource / Mean (SD) / Median [range]
Bingol 2005 [82] / Turkey / Overall COPD / Oral prednisolone (20 mg/daily) / ICU stay / Days / 20 / - / 1.4 (0.68) / -
Hospital stay / 20 / - / 8.3 (1.17) / -
Placebo / ICU stay / 20 / - / 5.2 (3.25) / -
Hospital stay / 20 / - / 12.95 (2.95) / -
Nikolakopoulou 2010 [108] / Greece / Overall COPD / Overall COPD / Duration of hospitalisation / Days / 80 / - / 11.2 (5.8) / -
Ornek 2012 [110] / Turkey / Overall COPD / Overall / Duration of hospitalisation / Days / 284 / - / 11.38 (6.94) / [Range: 1, 49]
Standard ward / 265 / - / 9.32 (5.17) / [Range: 1, 36]
ICU / 106 / - / 7.19 (7.05) / [Range: 1, 43]
Gabriel 2011 [53] / Romania / Overall COPD / GOLD+: Symptomatic / Hospital services utilisation rate / 1000/year / - / - / 19.6 / (95% CI: 7.4, 16.3)
GOLD+: No symptoms / - / - / 3.3 / (95% CI: 0.8, 13.2)
Study name / Country / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Total cost / Mean (SD) / Median (range) (95% CI)
Murtagh 2006 [40] / Ireland / Overall COPD / Overall COPD / 2000 / Sterling Pound (£) / Accident and emergency / 49 / - / 1.04 (7.29) / (Range: 0, 51)
Total GP visits costs / 49 / - / 19.81 (50.09) / (Range: 0, 228)
Outpatient day costs / 49 / - / 9.06 (53.69) / (Range: 0, 370)
HOSPITAL COST
Murtagh 2006 [40] / Ireland / Overall COPD / Overall COPD / 2000 / Sterling Pound (£) / Total Hospital costs / 49 / - / 54.55 (24.96) / (Range: 0, 1210)
Ornek 2012 [110] / Turkey / Overall COPD / Hospitalisations due to exacerbations in past 1 year more than 1: Present / NR / USD / Hospitalisation cost / 69 / - / 2082 (2852) / -
43 / - / 2181 (3104) / -
Hospitalisation longer than 7 days: Present / 198 / - / 2193 (2384) / -
History of smoking: Present / 174 / - / 1895 (2342) / -
Smoking 40 pack-age-years or more: Present / 101 / - / 2266 (2858) / -
Presence of co-morbidities: Present / 266 / - / 1834 (2191) / -
Presence of more than 1 comorbidities: Present / 190 / - / 2041 (2434) / -
Admission to ICU: Present / 106 / - / 3217 (2914) / -
NIMV: Present / 126 / - / 2185 (1848) / -
IMV: Present / 52 / - / 4415 (3465) / -
Exitus: Present / 42 / - / 4033 (3510) / -
Hospitalisations due to exacerbations in past 1 year more than 1: Absent / 98 / - / 1126 (1068) / -
Hospitalisations due to exacerbations in past 1 year more than 2: Absent / 124 / - / 1292 (1484) / -
Hospitalisation longer than 7 days: Absent / 86 / - / 782 (805) / -
History of smoking: Absent / 105 / - / 1487 (1652) / -
Smoking 40 pack-age-years or more: Absent / 71 / - / 1383 (1186) / -
Presence of co-morbidities: Absent / 18 / - / 748 (372) / -
Presence of more than 1 comorbidities: Absent / 94 / - / 1209 (1189) / -
Admission to ICU: Absent / 178 / - / 901 (512) / -
NIMV: Absent / 158 / - / 1431 (2296) / -
IMV: Absent / 232 / - / 1172 (1010) / -
Exitus: Absent / 242 / - / 1372 (1492)
Presence of comorbidities: Hypertension / 122 / - / 1627 (1696) / -
Presence of comorbidities: CAP / 115 / - / 1907 (1931) / -
Presence of comorbidities: CHF / 74 / - / 3597 (4591) / -
Presence of comorbidities: Hospital-acquired pneumonia / 70 / - / 3293 (3358) / -
Presence of comorbidities: Diabetes mellitus / 64 / - / 1555 (1754) / -
Presence of comorbidities: Pneumoconiosis / 49 / - / 1813 (2365) / -
Presence of comorbidities: Pulmonary embolism / 35 / - / 1743 (1883) / -
Presence of comorbidities: CHD / 25 / - / 1449 (1381) / -
Presence of comorbidities: Sleep apnoea / 18 / - / 1575 (1341) / -
Presence of comorbidities: CRF / 17 / - / 2280 (1697) / -
Presence of comorbidities: Malignancy / 16 / - / 2436 (2313) / -
Presence of comorbidities: Anaemia / 13 / - / 3896 (3393) / -
Absence of comorbidities: Hypertension / 162 / - / 1870 (2419) / -
Absence of comorbidities: CAP / 169 / - / 1669 (2270) / -
Absence of comorbidities: CHF / 211 / - / 3246 (3829) / -
Absence of comorbidities: Hospital-acquired pneumonia / 214 / - / 1266 (1187) / -
Absence of comorbidities: Diabetes mellitus / 220 / - / 1827 (2238) / -
Absence of comorbidities: Pneumoconiosis / 235 / - / 1756 (2094) / -
Absence of comorbidities: Pulmonary embolism / 249 / - / 1769 (2176) / -
Absence of comorbidities: CHD / 259 / - / 1796 (2198) / -
Absence of comorbidities: Sleep apnoea / 266 / - / 1778 (2183) / -
Absence of comorbidities: CRF / 267 / - / 1733 (2162) / -
Absence of comorbidities: Malignancy / 268 / - / 1726 (2126) / -
Absence of comorbidities: Anaemia / 271 / - / 1663 (2014) / -
Study name / Country / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Total cost / Mean (SD)
Edelman 2008 [94] / US / Overall COPD / Overall COPD / NR / USD / Hospital cost / 14 / - / 67,022 (132,784)
Stein 2010 [123] / US / Overall COPD / Algorithm 1 / 2006 / USD / Hospitalisation cost / - / - / -
Algorithm 2 / - / - / -
Algorithm 3 / - / - / -
Algorithm 4 / - / - / -
Algorithm 5 / - / - / -
Tsai 2013* [125] / US / Overall COPD / Non-invasive ventilation alone / NR / USD / Hospital charge / - / - / -
Invasive mechanical ventilation alone / - / - / -
Combined use / - / - / -
Study name / Country / Type of COPD / Study group(s) / Resource use item / Units/Timeframe / N / Mean (SD) / Median
Drescher 2008 [92] / US / Overall COPD / Intervention group (January through March 2006) / LOS (over 3 months) / Days / - / 5.5 (4) / 5 / -
Historical group (January through March 2004) / - / 6.5 (5) / 6 / -
Edelman 2008 [94] / US / Overall COPD / Overall COPD / LOS / Days / 14 / 22 / 37 [range: 1, 122] / -
Lindenauer 2007 [102] / US / Overall COPD / COPD: Care provided by hospitalists / LOS / Days / 2239 / 3 [95% CI: 2.9, 3.2] / - / -
COPD: Care provided by general internists / 3067 / 3.7 [95% CI: 3.5, 3.8] / - / -
COPD: Care provided by family physicians / 1770 / 3.6 [95% CI: 3.4, 3.7] / - / -
HOSPITAL DAYS
Stein 2010 [123] / US / Overall COPD / Algorithm 1 / Hospital days / Per hospitalisation / - / - / 4 [IQR: 2, 6] / -
Algorithm 2 / - / - / 4 [IQR: 2, 6] / -
Algorithm 3 / - / - / 4 [IQR: 2, 6] / -
Algorithm 4 / - / - / 4 [IQR: 2, 6] / -
Algorithm 5 / - / - / 4 [IQR: 3, 7] / -
Algorithm 1 / - / - / 2,000,000 [95% CI: 1,900,000, 2,100,000] / -
Algorithm 2 / - / - / 2,700,000 [95% CI: 2,500,000, 2,800,000] / -
Algorithm 3 / - / - / 2,700,000 [95% CI: 2,600,000, 2,900,000] / -
Algorithm 4 / - / - / 2,900,000 [95% CI: 2,700,000, 3,000,000] / -
Algorithm 5 / - / - / 5,100,000 [95% CI: 4,800,000, 5,400,000] / -
NUMBER OF HOSPITALISATIONS
Stein 2010 [123] / US / Algorithm 1 / No. of hospitalisations / Hospitalisations / - / - / 421,000 [95% CI: 395,000, 447,000] / -
Algorithm 2 / - / - / 557,000 [95% CI: 524,000, 591,000] / -
Algorithm 3 / - / - / 582,000 [95% CI: 547,000, 617,000] / -
Algorithm 4 / - / - / 599,000 [95% CI: 563,000, 634,000] / -
Algorithm 5 / - / - / 870,000 [95% CI: 817,000, 922,000] / -
Golmohammadi 2004 [97] / Canada / Overall COPD / Before Community-based rehabilitation program (Stage 1) / Emergency visits / Visits / 31 / 41.2 (SE: 13) / - / -
Before Community-based rehabilitation program (Stage 2A) / 78 / 57 (SE: 14.7) / - / -
Before Community-based rehabilitation program (Stage 2B) / 51 / 29.5 (SE: 12.3) / - / -
Before Community-based rehabilitation program (Stage 3) / 41 / 41 (SE: 13.7) / - / -
After Community-based rehabilitation program (Stage 1) / 31 / 13.6 (SE: 7.9) / - / -
After Community-based rehabilitation program (Stage 2A) / 78 / 44.8 (SE: 11.2) / - / -
After Community-based rehabilitation program (Stage 2B) / 51 / 16.3 (SE: 6.7) / - / -
After Community-based rehabilitation program (Stage 3) / 41 / 54.4 (SE: 27.6) / - / -
Tsai 2013* [125] / US / Overall COPD / Non-invasive ventilation alone / Annual ED visits / Annual visits / 10,032 / - / 42,704 [IQR: 29,505, 62,470] / -
Invasive mechanical ventilation alone / 15,427 / - / 44,119 [IQR: 29,895, 64,097] / -
Combined use / 2311 / - / 46,695 [IQR: 31,298, 66,235] / -
PHYSICIAN VISIT
Martinez 2012 [103] / US / Overall (only COPD) / Male with COPD / Physician visits: Any physician / No. of visits in prior 12 months / 273 / 7.7 (6.3) / - / -
Female with COPD / 295 / 6.8 (5.2) / - / -
Male with COPD / Physician visits: Pulmonologist / 273 / 2.8 (3) / - / -
Female with COPD / 295 / 2.9 (3.6) / - / -
Study name / Country / Type of COPD / Study group(s) / Cost year / Currency / Type of cost / Cost item / N / % cost
HOSPITAL STAY
Nangia 2010 [105] / India / Overall COPD / Procalcitonin group / Hospital stay / Days / - / 7.5 (2.5)
Control group / - / 7.3 (2.3)
HOSPITALISATION EVENTS
Nishimura 2011 [109] / Japan / Overall COPD / Included patients / Hospitalisation events / - / 189 / 300 / -
Analysed patients / - / 165 / 276 / -
Analysed patients / Hospitalisation events without oxygen, without NPPV / - / 165 / 44 / -
Hospitalisation events with oxygen, without NPPV / - / 165 / 122 / -
Hospitalisation events with oxygen, with NPPV / - / 165 / 110 / -
LENGTH OF HOSPITAL STAY
Asai 2011 [77] / Japan / Mild/moderate/severe/Very severe / Azithromycin / Length of admissions / Days / 12 / - / 9.9
IV / 17 / - / 12.5
Azithromycin / LOS for cured cases / 12 / - / 6.2
Intravenous / 17 / - / 11.9
Nishimura 2011 [109] / Japan / Overall COPD / Analysed patients / LOS / Days / 165 / - / 20.3; 15^
Ramnath 2012 [113] / India / Overall COPD / Overall COPD / LOS / Days / - / - / 8.52 (3.66)
TREATMENT/MEDICATION COSTS
Study name / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Total cost / Mean (SD)
Confronting COPD Survey: Global (Wouters 2003)* [38] / Overall COPD / France / Euros / Anticholinergics/Anticholinergics via nebulizer / 400 / 9
Inhaled corticosteroids / 400 / 67
Leukotriene receptor antagonist / 400 / 11
LABA / 400 / 9
NSAIDs / 400 / 3
SABA / 400 / 14
Theophylline / 400 / 2
Antibiotics for respiratory infections / 400 / 15
Influenza vaccines / 400 / 3
Home oxygen therapy / 400 / 133
Canada / CAD$ / Anticholinergics/Anticholinergics via nebulizer / 401 / 34.49
Inhaled corticosteroids / 401 / 79.93
Leukotriene receptor antagonist / 401 / 27.9
LABA / 401 / 26.47
NSAIDs / 401 / 2.99
SABA / 401 / 61.04
Systemic corticosteroids / 401 / 0.06
Theophylline / 401 / 4.12
Bupropion / 401 / 0.16
Antibiotics for respiratory infections / 401 / 33.26
Influenza vaccines / 401 / 4.22
Home oxygen therapy / 401 / 332.15
USA / USD / Anticholinergics / 447 / 10.92 (18.25)
Inhaled corticosteroids / 447 / 17.02 (25.24)
Leukotriene receptor antagonist / 447 / 0.52 (1.76)
LABA / 447 / 2.21 (6.98)
NSAIDs / 447 / 0 (0.02)
SABA / 447 / 21.52 (24.27)
Systemic corticosteroids / 447 / 0.98 (3.89)
Theophylline / 447 / 0.53 (1.47)
Course of antibiotics (primary care or emergency or/during inpatient stay) / 447 / 142.74 (426.49)
Influenza vaccines / 447 / 5.13 (4.16)
Home oxygen therapy (Use per day for concentrator/cylinder) / 447 / 40.33 (77.4)
Italy / Euros / Anticholinergics/Anticholinergics via nebulizer / 400 / 6.52
Inhaled corticosteroids / 400 / 42.86
Leukotriene receptor antagonist / 400 / 17.42
LABA / 400 / 25.79
NSAIDs / 400 / 6.18
SABA/SABA via nebulizer / 400 / 6.23
Systemic corticosteroids / 400 / 0.04
Theophylline / 400 / 5.87
Antibiotics for respiratory infections / 400 / 2.72
Influenza vaccines / 400 / 7.26
Home oxygen therapy (use per day for concentrator/cylinder) / 400 / 82.23
The Netherlands / 2002 / Euros / Prescribed anticholinergics / 415 / 39.38
Inhaled corticosteroids / 415 / 139.15
Leukotriene receptor antagonists / 415 / 4.34
Short-acting beta-2 agonists / 415 / 57.01
Systemic corticosteroids / 415 / 1.45
Theophylline / 415 / 3.84
Bupropion / 415 / 1.46
Antibiotic course / 415 / 7.5
influenza vaccine / 415 / 7.93
Home oxygen use / 415 / 43.34
Long-acting beta 2 agonists / 415 / 53.14
NSAIDs / 415 / 1.17
Spain / Euros / Anticholinergics/Anticholinergics via nebulizer / 402 / 18.49
Inhaled corticosteroids / 402 / 28.69
Leukotriene receptor antagonist / 402 / 3.36
LABA / 402 / 20.83
SABA/SABA via nebulizer / 402 / 17.38
Systemic corticosteroid / 402 / 0.01
Theophylline / 402 / 5.36
Antibiotics for respiratory infections / 402 / 9.75
Influenza vaccines / 402 / 2.24
Home oxygen therapy / 402 / 143.82
UK / Pounds (Euros) / Anticholinergics/Anticholinergics via nebulizer / 400 / 18.39 (28.50)a
Inhaled corticosteroids / 400 / 28.66 (44.42)a
Leukotriene receptor antagonist / 400 / 10.66 (16.52)a
LABA / 400 / 28.41 (44.03)a
NSAIDs / 400 / 1.79 (2.77)a
SABA/SABA via nebulizer / 400 / 23.59 (36.56)a
Systemic corticosteroids / 400 / 0.11 (0.18)a
Theophylline / 400 / 0.82 (1.26)a
Bupropion / 400 / 0.14 (0.22)a
Antibiotics for respiratory infections / 400 / 14.45 (22.40)a
Influenza vaccines / 400 / 3.52 (5.46)a
Home oxygen therapy (use per day for concentrator/cylinder)) / 400 / 22.30 (34.65)a
Study name / Type of COPD / Study group(s) / Cost year / Currency / Cost item / N / Total cost / Mean (SD) / Median [range] (95% CI)
THERAPY COST