Background Chronic obstructive pulmonary disease (COPD) is a growing economic burden worldwide. Smoking cessation is thought to be the single most effective way of reducing the economic burden of COPD. The impact of other strategies such as interventions that predict risk of disease, reduce progression of disease, or reduce exacerbations has not been systematically studied. Objectives We estimated the economic and clinical burden of COPD over the next 25 years in Canada and the impact of three potential interventions (screening test for predisposition to COPD, new drugs to avoid progression into more severe disease stages, and predictive test for exacerbations) on COPD burden. Methods Using a dynamic simulation model, we projected the total burden of COPD (cost, morbidity, and mortality) from 2011 to 2035 using the population of Canada as a case study. The model stratified population based on sex, age, smoking status, respiratory symptoms, and their COPD stage. The cost and quality adjusted life years (QALYs) associated with each intervention were estimated. Results The model indicates that annual societal cost of COPD is $4.52 billion (B) Canadian dollars in 2011 and will reach $3.61B ($7.33B undiscounted) per year in 2035. Over the next 25 years, COPD will be responsible for approximately $101.4B in societal costs ($147.5B undiscounted) and 12.9 million QALYs lost (19.0 million undiscounted). Our results suggested that the best strategy to reduce the financial burden of COPD is by reducing exacerbations. Smoking cessation, while it is the cornerstone of COPD prevention, has only a modest effect in attenuating the financial burden of COPD over the next 25 years in Western countries such as Canada. Conclusion Our data suggest that any intervention that can reduce the number of exacerbations has a substantial impact on morbidity and costs of COPD and should be considered in conjunction with the ongoing efforts to reduce smoking rates.
References
[1]
Mannino DM, Buist AS (2007) Global burden of COPD: risk factors, prevalence, and future trends. Lancet 370: 765–773.
[2]
Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3: e442.
[3]
Minino AM, Xu J, Kochanek KD (2008) Deaths: Preliminary Data for 2008. In: National Vital Statistics Reports. Vol. 59 N, editor.
[4]
Sin DD, McAlister FA, Man SF, Anthonisen NR (2003) Contemporary management of chronic obstructive pulmonary disease: scientific review. Jama 290: 2301–2312.
[5]
Patel AR, Hurst JR, Wedzicha JA (2010) The potential value of biomarkers in diagnosis and staging of COPD and exacerbations. Semin Respir Crit Care Med 31: 267–275.
[6]
Dahl M, Nordestgaard BG (2009) Markers of early disease and prognosis in COPD. Int J Chron Obstruct Pulmon Dis 4: 157–167.
[7]
Stolz D, Christ-Crain M, Morgenthaler NG, Leuppi J, Miedinger D, et al. (2007) Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 131: 1058–1067.
[8]
Population Projections for Canada, Provinces and Territories 2009 to 2036. Statistics Canada
[9]
Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, et al. (2007) International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 370: 741–750.
[10]
Parkes G, Greenhalgh T, Griffin M, Dent R (2008) Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ 336: 598–600.
[11]
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, et al. (2007) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176: 532–555.
[12]
Camp PG, Chaudhry M, Platt H, Roch M, Road J, et al. (2008) The sex factor: epidemiology and management of chronic obstructive pulmonary disease in British Columbia. Can Respir J 15: 417–422.
[13]
Spencer M, Briggs AH, Grossman RF, Rance L (2005) Development of an economic model to assess the cost effectiveness of treatment interventions for chronic obstructive pulmonary disease. Pharmacoeconomics 23: 619–637.
[14]
Hurst JR, Vestbo J, Anzueto A, Locantore N, Mullerova H, et al. (2010) Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 363: 1128–1138.
[15]
Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33: 337–343.
[16]
Rutten-van Molken MP, Oostenbrink JB, Tashkin DP, Burkhart D, Monz BU (2006) Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages? Chest 130: 1117–1128.
[17]
Johnson JA, Pickard AS (2000) Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. Med Care 38: 115–121.
[18]
Akazawa M, Halpern R, Riedel AA, Stanford RH, Dalal A, et al. (2008) Economic burden prior to COPD diagnosis: a matched case-control study in the United States. Respir Med 102: 1744–1752.
[19]
Mapel DW, Robinson SB, Dastani HB, Shah H, Phillips AL, et al. (2008) The direct medical costs of undiagnosed chronic obstructive pulmonary disease. Value Health 11: 628–636.
[20]
Chapman KR, Bourbeau J, Rance L (2003) The burden of COPD in Canada: results from the Confronting COPD survey. Respir Med 97: S23–31.
[21]
Tashkin DP, Murray RP (2009) Smoking cessation in chronic obstructive pulmonary disease. Respir Med 13: 13.
[22]
Bize R, Burnand B, Mueller Y, Rege Walther M, Cornuz J (2009) Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev CD004705.
[23]
Ramsey SD, Sullivan SD (2004) Chronic obstructive pulmonary disease: is there a case for early intervention? Am J Med 20: 3S–10S.
[24]
Jones PW, Agusti AG (2006) Outcomes and markers in the assessment of chronic obstructive pulmonary disease. Eur Respir J 27: 822–832.
[25]
Gamble E, Grootendorst DC, Hattotuwa K, O'Shaughnessy T, Ram FS, et al. (2007) Airway mucosal inflammation in COPD is similar in smokers and ex-smokers: a pooled analysis. Eur Respir J 30: 467–471.
[26]
Wedzicha JA, Seemungal TA (2007) COPD exacerbations: defining their cause and prevention. Lancet 370: 786–796.
[27]
Hansel TT, Barnes PJ (2009) New drugs for exacerbations of chronic obstructive pulmonary disease. Lancet 374: 744–755.
[28]
Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Molken MP (2003) Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD. Thorax 65: 711–718.
[29]
Hoogendoorn M, Rutten-van Molken MP, Hoogenveen RT, van Genugten ML, Buist AS, et al. (2005) A dynamic population model of disease progression in COPD. Eur Respir J 26: 223–233.
[30]
Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Molken MP (2010) Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD. Thorax 65: 711–718.
[31]
Hoogendoorn M, Rutten-van Molken MP, Hoogenveen RT, Al MJ, Feenstra TL (2011) Developing and applying a stochastic dynamic population model for chronic obstructive pulmonary disease. Value Health 14: 1039–1047.
[32]
Brennan A, Chick SE, Davies R (2006) A taxonomy of model structures for economic evaluation of health technologies. Health economics 15: 1295–1310.
[33]
Liu JS, Chen R (1998) Sequential Monte Carlo methods for dynamic systems. Journal of the American statistical association 93: 1032–1044.
[34]
Gershon AS, Guan J, Wang C, To T (2010) Trends in asthma prevalence and incidence in Ontario, Canada, 1996–2005: a population study. Am J Epidemiol 172: 728–736.
[35]
Gershon AS, Warner L, Cascagnette P, Victor JC, To T (2011) Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study. Lancet 378: 991–996.
[36]
Mannino DM, Gagnon RC, Petty TL, Lydick E (2000) Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 160: 1683–1689.
[37]
Schneider A, Gindner L, Tilemann L, Schermer T, Dinant GJ, et al. (2009) Diagnostic accuracy of spirometry in primary care. BMC Pulm Med 9: 31.
