Direct medical costs of COPD diagnosis and treatment, Eastern vs Western European country – examples of Serbia and Belgium
DOI:
https://doi.org/10.7175/fe.v14i4.676Keywords:
COPD, Direct costs, GPDAbstract
OBJECTIVE: Comparison of COPD financial burden and underlying factors, between Eastern upper middle income and a Western European high income, healthcare settings.
METHODS: The patient sample was 433 in Belgium and 322 in Serbia, age ≥ 40, with spirometry and clinically confirmed COPD diagnosis. Belgian trial followed patients prospectively during 2006, using structured survey of clinicians in charge. Serbian trial conducted in 2008, retrieved data from clinical invoice database. Time horizon was one year and perspective of third party payers was taken into account for both studies. Clinical outcomes of interest were disease exacerbation, hospital admission and death. Economic inputs referred to COPD-attributable medical services consumption value during observed period of time.
RESULTS: Average annual cost was 1,812.84 € for the Serbian patients and 1,738.13 €/year for the Belgian patients (not including the value of laboratory diagnostics or imaging techniques). Severity grade and duration of hospital admissions significantly directly correlated with overall cost in both populations. Pattern of diagnostic procedures requested and ATC classes of drug consumed to treat COPD remains similar and comparable in both countries. GDP per capita ratio in respective years (10.4: 37.4), exhibits the paradox of patient being much less affordable to treat in a less developed society.
CONCLUSIONS: Burden of COPD in Europe is huge and, due to contemporary life style expected to grow further. We compared cost of illness structures between two societies with different macroeconomic past in healthcare financing and management. According to our findings, direct medical costs were driven by exacerbations and hospital admissions. Significantly cheaper human labor caused higher relative relevance of drug acquisition expenses in the East and higher portion of hospital admission costs in the West. More in-depth research of indirect COPD attributable costs (e.g. lost productivity, absenteeism, premature death etc) will be needed in future. It implies serious health policy necessities to provide accessibility of care.
References
Halpin DM, Miravitlles M. Chronic Obstructive Pulmonary Disease: the disease and its burden to society. Proc Am Thorac Soc 2006; 3: 619-23; http://dx.doi.org/10.1513/pats.200603-093SS
Ramsey SD, Sullivan SD. The burden of illness and economic evaluation for COPD. Eur Respir J 2003; 21: 29s-35; http://dx.doi.org/10.1183/09031936.03.00078203
Chapman KR, Mannino DM, Soriano JB, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J 2006; 27: 188-207; http://dx.doi.org/10.1183/09031936.06.00024505
Skrepnek GH, Skrepnek SV. Epidemiology, clinical and economic burden, and natural history of chronic obstructive pulmonary disease and asthma. Am J Manag Care 2004; 10(5): 129-38.
Halbert RJ, Natoli JL, Gano A, et al. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006; 28: 523-32; http://dx.doi.org/10.1183/09031936.06.00124605
Institute of Public Health of Serbia. Health Statistical Yearbook of Republic of Serbia, 2011. Belgrade: Institute of Public Health of Serbia, 2012
Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397-412; http://dx.doi.org/10.1183/09031936.06.00025805
World Economic Outlook 2009. A survey by the staff of the International Monetary Fund. Washington DC; 2009. Available at: http://www.imf.org/external/pubs/ft/weo/2009/02/pdf/text.pdf (last accessed December 2012)
The World Health Report 2008 – Primary Health Care: now more than ever. Geneva: World Health Organisation; 2008. Available at: http://www.who.int/whr/2008/whr08_en.pdf (last accessed December 2012)
Jakovljevic MB. Resource allocation strategies in Southeastern European health policy. Eur J Health Econ 2013; 14: 153-9; http://dx.doi.org/10.1007/s10198-012-0439-y
Annemans L. Health Economics for Non-Economists: An Introduction to the concepts, methods and pitfalls of health economic evaluations. Belgium: Academia Press, 2008
Cottem D. Effects of the Belgian health care policy on the conceptual choice of a hospital information system. Stud Health Technol Inform 2002; 93: 95-101
Minkoff BN, Leff DR, Hilleman ED. New Concepts to Improve Health Outcomes for Patients With Chronic Obstructive Pulmonary Disease. J Manag Care Pharm 2005; 11: S-a
Miravitlles M, Murio C, Guerrero T, et al. Costs of chronic bronchitis and COPD: a 1-year follow-up study. Chest 2003; 123: 784-91; http://dx.doi.org/10.1378/chest.123.3.784
Koleva D, Motterlini N, Banfi P, et al.; Study Group BIC. Healthcare costs of COPD in Italian referral centres: a prospective study. Respir Med 2007; 101: 2312-20; http://dx.doi.org/10.1016/j.rmed.2007.06.020
Halpin DM. Health economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2006; 3: 227-33; http://dx.doi.org/10.1513/pats.200507-072SF
Brundtland HG. The Tobacco Atlas. World Health Organisation; 2004. Available at: http://www.who.int/tobacco/media/en/title.pdf (last accessed December 2012)
Jansson SA, Andersson F, Borg S, et al. Costs of COPD in Sweden according to disease severity. Chest 2002; 122: 1994-2002; http://dx.doi.org/10.1378/chest.122.6.1994
Mannino DM, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007; 4: 502-6; http://dx.doi.org/10.1513/pats.200701-001FM
Bilde L, Rud Svenning A, Dollerup J, et al. The cost of treating patients with COPD in Denmark--a population study of COPD patients compared with non-COPD controls. Respir Med 2007; 101: 539-46; http://dx.doi.org/10.1016/j.rmed.2006.06.020
Dal Negro RW, Tognella S, Tosatto R, et al. Costs of chronic obstructive pulmonary disease (COPD) in Italy: the SIRIO study (social impact of respiratory integrated outcomes). Respir Med 2008; 102(1): 92-101; http://dx.doi.org/10.1016/j.rmed.2007.08.001
Chen YH, Yao WZ, Cai BQ, et al. Economic analysis in admitted patients with acute exacerbation of chronic obstructive pulmonary disease. Chin Med J 2008; 121: 587-91
Gerdtham UG, Andersson LF, Ericsson A, et al. Factors affecting chronic obstructive pulmonary disease (COPD)-related costs: a multivariate analysis of a Swedish COPD cohort. Eur J Health Econ 2009; 10: 217-26; http://dx.doi.org/10.1007/s10198-008-0121-6
Strassels SA, Smith DH, Sullivan SD, et al. The Costs of Treating COPD in United States. Chest 2001; 119: 344-52; http://dx.doi.org/10.1378/chest.119.2.344
Nowak D, Dietrich ES, Oberender P, et al. Cost-of-illness Study for the Treatment of COPD in Germany. Pneumologia 2004; 58: 837-44; http://dx.doi.org/10.1055/s-2004-830143
Nielsen R, Johannessen A, Benediktsdottir B, et al. Present and future costs of COPD in Iceland and Norway: results from the BOLD study. Eur Respir J 2009; 34: 850-7; http://dx.doi.org/10.1183/09031936.00166108
Strâmbu I, Bucşa S, Nicolescu D, et al. Cost analysis in patients admitted with COPD in 2002. Pneumologia 2004; 53: 161-8
Jahnz-Rózyk K, Targowski T, From S. Costs of exacerbations of chronic obstructive pulmonary disease in primary and secondary care in 2007- results of multicenter Polish study. Pol Merkur Lekarski 2009; 26: 208-14
Biorac N, Jakovljević M, Stefanović D, et al. Assessment of diabetes mellitus type 2 treatment costs in the Republic of Serbia. Vojnosanit Pregl 2009; 66: 271-6; http://dx.doi.org/10.2298/VSP0904271B
Jakovljevic M, Varjacic M, Jankovic SM. Cost-effectiveness of ritodrine and fenoterol for treatment of preterm labor in a low-middle-income country: a case study. Value Health 2008; 11: 149-53; http://dx.doi.org/10.1111/j.1524-4733.2007.00222.x
Jovanovic M, Jakovljevic M. Inpatient detoxification procedure and facilities: financing considerations from an Eastern European perspective. Alcohol Alcohol 2011; 46: 364-5; http://dx.doi.org/10.1093/alcalc/agr010
Jakovljević M, Jovanović M . Sadašnji status i troškovi lečenja opioidne zavisnosti u domaćem zdravstvenom sektoru. Psihijatrija danas 2011; 43: 197-9
Cupurdija V, Lazic Z, Jakovljevic M. Cost of illness of community-acquired pneumonia. Review of the literature and possible strategies in the Serbian health care setting. Farmeconomia. Health economics and therapeutic pathways 2012; 13: 133-9; http://dx.doi.org/10.7175/fe.v13i3.275
Jakovljevic M, Jovanovic M, Nikic K, et al. Inpatient detoxification and law enforcement costs following acute drinking event, in typical eastern European upper – middle income, health care setting. Health Behavior & Public Health 2011; 1: 1-7
Radovanovic A, Dagovic A , Jakovljevic M. Economics of cancer related medical care: estimates worldwide and available domestic evidence. Arch Oncol 2011; 19: 59-63; http://dx.doi.org/10.2298/AOO1104059R
Jakovljevic M, Jovanovic M, Lazic Z, et al. Current efforts and proposals to reduce healthcare costs in Serbia. Ser J Exp Clin Res 2011; 12: 161-3; http://dx.doi.org/10.5937/sjecr1104161J
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (see The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)
