.: ORİJİNAL ARAŞTIRMA
Economic Burden and Key Cost Drivers of Managing Hospitalized Chronic Obstructive Pulmonary Disease Patients Admitted with an Exacerbation in Türkiye: A Cost of Illness Study from Payer Perspective
Türkiye'de Alevlenme ile Yatırılan Kronik Obstrüktif Akciğer Hastalarının Yönetiminde Anahtar Maliyet Kalemleri ve Ekonomik Yük: Geri Ödeyici Perspektifinden Hastalık Maliyeti Çalışması
Turkiye Klinikleri Arch Lung. 2022;21(2):39-50
doi: 10.5336/archlung.2022-88430
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: To estimate the economic burden and key cost drivers of managing exacerbated and hospitalized chronic obstructive pulmonary disease (COPD) patients in Türkiye. Material and Methods: This cost of illness study was based on an estimation of per patient annual direct medical costs for the management of exacerbated and hospitalized COPD patients in Türkiye from a payer perspective. The average per patient direct medical cost was calculated based on cost items related to outpatient visits, diagnostic laboratory and radiological tests, hospitalizations and interventions, training and rehabilitation, drug treatment and equipment, drug-related adverse events, and co-morbidities/complications. Results: Based on average annual per patient costs calculated for outpatient admission ($88.5), laboratory and radiological tests ($68.6), hospitalizations and interventions/training/rehabilitation ($1,181.3), drug treatment/equipment ($1,088.0), co-morbidities/complications ($1,291.7) and drug related adverse events ($11.8) cost items, per patient annual direct medical cost related to the management of exacerbated and hospitalized COPD patients was calculated to be $3,729.9 from the payer perspective. Co-morbidities/complications (34.6%), hospitalizations/interventions (31.7%) and drug treatment/equipment (29.2%) were the key cost driver. Results: In conclusion, our findings indicate that managing exacerbated and hospitalized COPD patients pose a considerable burden to health economics in Türkiye, with co-morbidities and hospitalizations estimated as the main cost drivers. Our findings emphasize the need for cost-effective prevention strategies and the likelihood of potential cost-savings by timely recognition and proper management of co-morbidities and by better disease control with reduced frequency of exacerbations and hospitalizations.
Keywords: Chronic obstructive pulmonary disease; exacerbations; practice patterns; cost analysis; Türkiye
Objective: To estimate the economic burden and key cost drivers of managing exacerbated and hospitalized chronic obstructive pulmonary disease (COPD) patients in Türkiye. Material and Methods: This cost of illness study was based on an estimation of per patient annual direct medical costs for the management of exacerbated and hospitalized COPD patients in Türkiye from a payer perspective. The average per patient direct medical cost was calculated based on cost items related to outpatient visits, diagnostic laboratory and radiological tests, hospitalizations and interventions, training and rehabilitation, drug treatment and equipment, drug-related adverse events, and co-morbidities/complications. Results: Based on average annual per patient costs calculated for outpatient admission ($88.5), laboratory and radiological tests ($68.6), hospitalizations and interventions/training/rehabilitation ($1,181.3), drug treatment/equipment ($1,088.0), co-morbidities/complications ($1,291.7) and drug related adverse events ($11.8) cost items, per patient annual direct medical cost related to the management of exacerbated and hospitalized COPD patients was calculated to be $3,729.9 from the payer perspective. Co-morbidities/complications (34.6%), hospitalizations/interventions (31.7%) and drug treatment/equipment (29.2%) were the key cost driver. Results: In conclusion, our findings indicate that managing exacerbated and hospitalized COPD patients pose a considerable burden to health economics in Türkiye, with co-morbidities and hospitalizations estimated as the main cost drivers. Our findings emphasize the need for cost-effective prevention strategies and the likelihood of potential cost-savings by timely recognition and proper management of co-morbidities and by better disease control with reduced frequency of exacerbations and hospitalizations.
Keywords: Chronic obstructive pulmonary disease; exacerbations; practice patterns; cost analysis; Türkiye
ÖZET
Amaç: Türkiye'de alevlenme geçiren ve hastanede yatırılarak tedavi edilen kronik obstrüktif akciğer hastalığı (KOAH) hastalarının ekonomik yükünü tespit etmek ve anahtar maliyet kalemlerini saptamak çalışmanın amacıdır. Gereç ve Yöntemler: Bu hastalık maliyeti çalışması geri ödeyici perspektifinden, yatırılarak tedavi edilen KOAH hastalığının yönetiminde hasta başı direkt maliyetleri hesaplamaya odaklanmıştır. Ortalama direkt tıbbi maliyetler poliklinik ziyaretleri, tanıda laboratuvar ve görüntüleme maliyetleri, yatış ve müdahaleler, eğitim ve rehabilitasyon, ilaç tedavisi ve komorbid ve komplikasyonlara ait maliyetleri kapsamaktadır. Bulgular: Ortalama hasta başı poliklinik ziyaretleri (88,5$), laboratuvar ve radyolojik test maliyeti (68,6 $), yatış ve müdahale/eğitim/rehabilitasyon (1.181,3$) ilaç tedavisi/tıbbi cihaz maliyeti (1.088,0$), komorbid/komplikasyon (1.291,7$) ve ilaç ilişkili yan etki maliyeti (11,8$) ve toplam hasta başı ortalama alevlenme ile yatış maliyeti 3.729,9 $ olarak geri ödeyici perspektifinden belirlenmiştir. Komorbiditeler ve komplikasyonlar (%34,6), yatış/ müdahale (%31,7) ve ilaç tedavi/cihaz maliyeti (%29,2) ile en yüksek maliyet kalemleri olarak tespit edilmiştir. Sonuç: Bulgularımız, alevlenme ile hastaneye yatan KOAH hastalarının Türkiye sağlık ekonomisine önemli bir yük getirdiğini göstermektedir. Komorbid hastalıklar ve yatış en önemli maliyet belirleyicileridir. Maliyet etkili ve zamanında maliyet tasarruflu potansiyel önleme stratejileri ile daha iyi hastalık kontrolü, komorbidlerin yönetimi ile alevlenmeler ve yatış sıklıkları azaltılabilir.
Anahtar Kelimeler: Kronik obstrüktif akciğer hastalığı; alevlenme; uygulama modeli; maliyet analizi; Türkiye
Amaç: Türkiye'de alevlenme geçiren ve hastanede yatırılarak tedavi edilen kronik obstrüktif akciğer hastalığı (KOAH) hastalarının ekonomik yükünü tespit etmek ve anahtar maliyet kalemlerini saptamak çalışmanın amacıdır. Gereç ve Yöntemler: Bu hastalık maliyeti çalışması geri ödeyici perspektifinden, yatırılarak tedavi edilen KOAH hastalığının yönetiminde hasta başı direkt maliyetleri hesaplamaya odaklanmıştır. Ortalama direkt tıbbi maliyetler poliklinik ziyaretleri, tanıda laboratuvar ve görüntüleme maliyetleri, yatış ve müdahaleler, eğitim ve rehabilitasyon, ilaç tedavisi ve komorbid ve komplikasyonlara ait maliyetleri kapsamaktadır. Bulgular: Ortalama hasta başı poliklinik ziyaretleri (88,5$), laboratuvar ve radyolojik test maliyeti (68,6 $), yatış ve müdahale/eğitim/rehabilitasyon (1.181,3$) ilaç tedavisi/tıbbi cihaz maliyeti (1.088,0$), komorbid/komplikasyon (1.291,7$) ve ilaç ilişkili yan etki maliyeti (11,8$) ve toplam hasta başı ortalama alevlenme ile yatış maliyeti 3.729,9 $ olarak geri ödeyici perspektifinden belirlenmiştir. Komorbiditeler ve komplikasyonlar (%34,6), yatış/ müdahale (%31,7) ve ilaç tedavi/cihaz maliyeti (%29,2) ile en yüksek maliyet kalemleri olarak tespit edilmiştir. Sonuç: Bulgularımız, alevlenme ile hastaneye yatan KOAH hastalarının Türkiye sağlık ekonomisine önemli bir yük getirdiğini göstermektedir. Komorbid hastalıklar ve yatış en önemli maliyet belirleyicileridir. Maliyet etkili ve zamanında maliyet tasarruflu potansiyel önleme stratejileri ile daha iyi hastalık kontrolü, komorbidlerin yönetimi ile alevlenmeler ve yatış sıklıkları azaltılabilir.
Anahtar Kelimeler: Kronik obstrüktif akciğer hastalığı; alevlenme; uygulama modeli; maliyet analizi; Türkiye
REFERANSLAR:
- Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Access date: 28 May 2018 Available at: [Link]
- Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-128. Erratum in: Lancet. 2013;381(9867):628. AlMazroa, Mohammad A [added]; Memish, Ziad A [added]. [PubMed]
- Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002;57(10):847-52. Erratum in: Thorax. 2008;63(8):753. [Crossref] [PubMed] [PMC]
- Hurst JR, Vestbo J, Anzueto A, Locantore N, Müllerova H, Tal-Singer R, et al.; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128-38. [Crossref] [PubMed]
- Deniz S, Şengül A, Aydemir Y, Çeldir Emre J, Özhan MH. Clinical factors and comorbidities affecting the cost of hospital-treated COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:3023-30. [Crossref] [PubMed] [PMC]
- Dalal AA, Patel J, D'Souza A, Farrelly E, Nagar S, Shah M. Impact of COPD exacerbation frequency on costs for a managed care po-pulation. J Manag Care Spec Pharm. 2015;21(7):575-83. [Crossref] [PubMed]
- Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD. 2012;9(2):131-41. [Crossref] [PubMed]
- Dhamane AD, Moretz C, Zhou Y, Burslem K, Saverno K, Jain G, et al. COPD exacerbation frequency and its association with health care resource utilization and costs. Int J Chron Obstruct Pulmon Dis. 2015;10:2609-18. [Crossref] [PubMed] [PMC]
- Müllerova H, Maselli DJ, Locantore N, Vestbo J, Hurst JR, Wedzicha JA, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147(4):999-1007. [Crossref] [PubMed]
- Roberts CM, Lopez-Campos JL, Pozo-Rodriguez F, Hartl S; European COPD Audit team. European hospital adherence to GOLD recommendations for chronic obstructive pulmonary disease (COPD) exacerbation admissions. Thorax. 2013;68(12):1169-71. [Crossref] [PubMed]
- Pasquale MK, Sun SX, Song F, Hartnett HJ, Stemkowski SA. Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. Int J Chron Obstruct Pulmon Dis. 2012;7:757-64. [Crossref] [PubMed] [PMC]
- Roberts MC, Hartl S, Lopes-Campos JL, COPD Audit Study Group. Results of the first European COPD Audit: An International Comparison of COPD Care in Europe. Lausanne, Switzerland; 2012. ISBN: 978-2-8399-0986-0
- Menn P, Heinrich J, Huber RM, Jörres RA, John J, Karrasch S, et al; KORA Study Group. Direct medical costs of COPD--an excess cost approach based on two population-based studies. Respir Med. 2012;106(4):540-8. [Crossref] [PubMed]
- Wouters EF. Economic analysis of the Confronting COPD survey: an overview of results. Respir Med. 2003;97 Suppl C:S3-14. [Crossref] [PubMed]
- Foo J, Landis SH, Maskell J, Oh YM, van der Molen T, Han MK, et al. Continuing to Confront COPD ınternational patient survey: economic impact of COPD in 12 countries. PLoS One. 2016;11(4):e0152618. [Crossref] [PubMed] [PMC]
- Erdinç E, Polatli M, Kocabas A, Yıldırım N, Gürgün A, Saryal S, et al. Türk Toraks Derneği kronik obstrüktif akciğer hastalığı tanı ve tedavi uzlaşı raporu [Turkish Thoracic Society Consensus Report on Diagnosis and Treatment of COPD]. Turkish Thoracic Journal 2010;11(suppl 1):A1-64. [Link]
- Foster TS, Miller JD, Marton JP, Caloyeras JP, Russell MW, Menzin J. Assessment of the economic burden of COPD in the U.S.: a review and synthesis of the literature. COPD. 2006;3(4):211-8. [Crossref] [PubMed]
- Detournay B, Pribil C, Fournier M, Housset B, Huchon G, Huas D, et al; SCOPE Group. The SCOPE study: health-care consumption related to patients with chronic obstructive pulmonary disease in France. Value Health. 2004;7(2):168-74. [Crossref] [PubMed]
- Nishimura S, Zaher C. Cost impact of COPD in Japan: opportunities and challenges? Respirology. 2004;9(4):466-73. [Crossref] [PubMed]
- Miravitlles M, Murio C, Guerrero T, Gisbert R. Costs of chronic bronchitis and COPD: a 1-year follow-up study. Chest. 2003;123(3):784-91. [Crossref] [PubMed]
- Koleva D, Motterlini N, Banfi P, Garattini L; Study Group BIC. Healthcare costs of COPD in Italian referral centres: a prospective study. Respir Med. 2007;101(11):2312-20. [Crossref] [PubMed]
- Schwab P, Dhamane AD, Hopson SD, Moretz C, Annavarapu S, Burslem K, Renda A, Kaila S. Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population. Int J Chron Obstruct Pulmon Dis. 2017;12:735-44. [Crossref] [PubMed] [PMC]
- Polatli M, Ben Kheder A, Wali S, Javed A, Khattab A, Mahboub B, et al; BREATHE Study Group. Chronic obstructive pulmonary disease and associated healthcare resource consumption in the Middle East and North Africa: the BREATHE study. Respir Med. 2012;106 Suppl 2:S75-85. [Crossref] [PubMed]
- Chapman KR, Mannino DM, Soriano JB, Vermeire PA, Buist AS, Thun MJ, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J. 2006;27(1):188-207. [Crossref] [PubMed]
- Torabipour A, Hakim A, Ahmadi Angali K, Dolatshah M, Yusofzadeh M. Cost analysis of hospitalized patients with chronic obstructive pulmonary disease: a state-level cross-sectional study. Tanaffos. 2016;15(2):75-82. [PubMed] [PMC]
- Gani R, Griffin J, Kelly S, Rutten-van Mölken M. Economic analyses comparing tiotropium with ipratropium or salmeterol in UK patients with COPD. Prim Care Respir J. 2010;19(1):68-74. [Crossref] [PubMed] [PMC]
- Wang Y, Stavem K, Dahl FA, Humerfelt S, Haugen T. Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Int J Chron Obstruct Pulmon Dis. 2014;9:99-105. [Crossref] [PubMed] [PMC]
- Nowak D, Dietrich ES, Oberender P, Uberla K, Reitberger U, Schlegel C, et al. Krankheitskosten von COPD in Deutschland [Cost-of-illness Study for the Treatment of COPD in Germany]. Pneumologie. 2004;58(12):837-44. German. [Crossref] [PubMed]
- Viegi G, Pistelli F, Sherrill DL, Maio S, Baldacci S, Carrozzi L. Definition, epidemiology and natural history of COPD. Eur Respir J. 2007;30(5):993-1013. [Crossref] [PubMed]
- Vestbo J, Anderson W, Coxson HO, Crim C, Dawber F, Edwards L, et al; ECLIPSE investigators. Evaluation of COPD longitudinally to identify predictive surrogate end-points (ECLIPSE). Eur Respir J. 2008;31(4):869-73. [Crossref] [PubMed]
- Mapel DW, Hurley JS, Frost FJ, Petersen HV, Picchi MA, Coultas DB. Health care utilization in chronic obstructive pulmonary disease. a case-control study in a health maintenance organization. Arch Intern Med. 2000;160(17):2653-8. [Crossref] [PubMed]
- Polsky D, Bonafede M, Suaya JA. Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults. BMC Health Serv Res. 2012;12:379. [Crossref] [PubMed] [PMC]
- Halpin DM, Miravitlles M. Chronic obstructive pulmonary disease: the disease and its burden to society. Proc Am Thorac Soc. 2006;3(7):619-23. [Crossref] [PubMed]
- Polatlı M, Bilgin C, Şaylan B, Başlılar Ş, Toprak E, Ergen H, et al; COPD-Life Study Group. A cross sectional observational study on the influence of chronic obstructive pulmonary disease on activities of daily living: the COPD-Life study. Tuberk Toraks. 2012;60(1):1-12. [Crossref] [PubMed]
- Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupré A, Bégin R, et al; Chronic Obstructive Pulmonary Disease axis of the Respiratory Network Fonds de la Recherche en Santé du Québec. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003;163(5):585-91. [Crossref] [PubMed]
.: İşlem Listesi