I costi della broncopneumopatia cronica ostruttiva: la fase prospettica dello Studio ICE (Italian Costs for Exacerbations in COPD)^*

The costs of COPD

Introduction

Chronic obstructive pulmonary disease (COPD) is a cause of morbidity and mortality worldwide and imposes a huge individual and social burden. The present article reports the results from the prospective phase (results from the retrospective one were already published) of a multicentre Italian study (ICE, Italian Costs for Exacerbations in COPD). The aim of ICE was to assess the direct and indirect costs due to COPD, particularly regarding its exacerbations.

Materials and methods

The prospective phase was carried out on COPD patients admitted to 25 Hospital Centres (spread throughout over the country) because of an exacerbation occurring during the quarter October-December 2002. A 6-month follow-up following discharge was performed in each patient, via three telephone interviews every second month, based on a standard questionnaire and conducted by a clinical investigator. The sample was statistically stratified by three areas: Northern, Central, and Southern Italy.

Results

570 patients (mean age = 70.6 years; males = 69.2%) were eventually considered for processing. According to GOLD severity scale, patients were distributed as follows: 2a (moderate) → 36.4%; 2b (moderate-severe) → 31.3%; 3 (severe) → 32.3%. Respiratory failure affected 51.9% of the patients. Disease severity was found to be linked to smoking habits. 42% of exacerbations required hospitalisation. Medical costs for COPD totalled to € 4,645.5 per patient/year (€ 2,423.1 were related to exacerbations, € 2,222.4 to routine treatment); 40.1% of the total amount was for hospitalisations, 30.2% for oxygen therapy, 18% for drugs. Indirect costs (due to productivity losses by the patient and/or caregivers) were € 91.6 per patient/year. Costs resulted positively related to disease severity and to respiratory failure.

Conclusions

COPD is a disease with high costs, chiefly borne by the National Health Service: even a conservative estimate would find COPD responsible for 6% of the whole health care expenditure in Italy. The largest share of costs is for hospitalisations; hence, a strategy might be cost-effective that aimed at reducing exacerbations by improving diagnostic procedures and different treatment strategies, including drug therapy and pulmonary rehabilitation.