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* From the Center Servei de Pneumologia (Drs. Miravitlles and Murio), Hospital General Universitari Vall d’Hebron, Barcelona; Pharma Research (Ms. Guerrero), Division of Pharma Consult Services S. A., Barcelona; and SOIKOS S. L. (Dr. Gisbert), Barcelona, Spain.
Correspondence to: Marc Miravitlles, MD, Rocafort 173-177, 3-1a, 08015 Barcelona, Spain; e-mail: marcm{at}separ.es
Background: Although exacerbations are the main cause of medical visits and hospitalizations of patients with chronic bronchitis and COPD, little information is available on the costs of their management.
Objective: This study attempted to determine the total direct costs derived from the management of exacerbations of chronic bronchitis and COPD in an ambulatory setting.
Method: A total of 2,414 patients with exacerbated chronic bronchitis and COPD were recruited from 268 general practices located throughout Spain. Patients were followed up for 1 month.
Results: A total of 507 patients (21%) relapsed; of these, 161 patients (31.7%) required attention in emergency departments and 84 patients (16.5%) were admitted to the hospital. The total direct mean cost of all exacerbations was $159; patients who were hospitalized generated 58% of the total cost. Cost per failure was $477.50, and failures were responsible for an added mean cost of $100.30/exacerbation. Exacerbations of the 1,130 patients with COPD had a mean cost of $141. Sensitivity analysis showed that a 50% reduction in the failure rate (from 21 to 10.5%) would result in a total cost of exacerbation of $107 (33% reduction).
Conclusion: Exacerbations of chronic bronchitis and COPD are costly, but the greatest part of costs derives from therapeutic failures, particularly those that end in hospitalization.
Key Words: chronic bronchitis • COPD • cost • exacerbation • failure • pharmacoeconomics • primary care • treatment
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