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      Determinants and predictors of the cost of COPD in primary care: A Spanish perspective

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          Abstract

          Objectives

          1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables.

          Patients and methods

          A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected.

          Results

          A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 ± 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV 1) value was 57.4 ± 13.4%. The total cost per patient per year was €1,922.60 ± 2,306.44. The largest component of this cost was hospitalization (€788.72 ± 1,766.65), followed by cost of drugs (€492.87 ± 412.15) and visits to emergency rooms (€134.32 ± 195.44). Linear regression analysis found associated heart disease, FEV 1, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost.

          Conclusions

          The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost.

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          Most cited references 13

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          [The impact of COPD on hospital resources: the specific burden of COPD patients with high rates of hospitalization].

          1) To know the impact of chronic obstructive pulmonary disease (COPD) on hospital care (visits to the emergency room and admission); and 2) to identify and describe COPD patients whose use of health care is high (COPD-HC), also assessing the costs generated by such patients. We reviewed the files of all patients with COPD receiving care at our hospital in 1998, looking at age, sex, smoking, simple spirometry, arterial gases at rest, number of admissions, duration of hospital stay, and number of visits to the emergency room. After describing the sample, patients were stratified in three groups by use of hospital care: group A, patients not requiring hospital care; group B, patients requiring less care than the COPD-HC group; and group C, COPD-HC. The criteria used to define the COPD-HC group were 1) >= 2 admissions in one year, 2) >= 3 visits to the emergency room, without admission in one year, or 3) 1 admission and 2 visits to the emergency room for COPD exacerbation in one year. Three hundred twenty cases were studied, 3 women (0.9%) and 317 men (99.1%), mean age 71 9 years. One hundred twenty-six patients (39.4%) made 263 visits in 1998, accounting for 1.1% of all emergencies (n = 23,750) and 4.05% of all medical emergencies (n = 6,489). Ninety-two patients (28.7%) were admitted for exacerbation of COPD. One hundred twenty-six admissions were made over the course of the year, accounting for 9.6% of all admissions to the internal medicine wards (n = 1,309). The 39 patients (12.2%) who were classified COPD-HC generated 160 emergency visits (60.8%) and 72 admissions due to COPD (57.1%). The analysis of variation revealed statistically significant differences among the 3 groups for age, FEV1, FVC and PaO2, but not for PaCO2. COPD-HC patients had the lowest values for FEV1, FVC and PaO2 and were older. COPD generates high demand for hospital care. A small group of COPD patients (12.2%) accounts for nearly 60% of hospital visits for this disease. The group requiring greater care generally has more severe disease (older, more severe bronchial obstruction and hypoxemia).
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            [Chronic obstructive pulmonary disease and cardiovascular events].

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              [Dyspnea and quality of life in chronic obstructive pulmonary disease].

               C Sanjuas (2002)
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                December 2008
                December 2008
                : 3
                : 4
                : 701-712
                Affiliations
                [1 ] Department of Pneumology, University Hospital Gregorio Marañón, Madrid, Spain
                [2 ] School of Health Sciences, Rey Juan Carlos University, Alcorcón (Madrid), Spain
                [3 ] Health Outcomes Research Department Medical Unit, Pfizer Spain, Alcobendas (Madrid), Spain
                [4 ] Department of Preventive Medicine, University Hospital Gregorio Marañón, Madrid, Spain
                Author notes
                Correspondence: J de Miguel Díez, Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain, Tel +34 9 1586 8331, Fax +34 9 1586 8018, Email jmiguel.hgugm@ 123456salud.madrid.org
                Article
                copd-3-701
                2650614
                19281084
                © 2008 Dove Medical Press Limited. All rights reserved
                Categories
                Original Research

                Respiratory medicine

                costs, spain, primary care, copd, predictors

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