Humanistic and Economic Burden of Severe Chronic Obstructive Pulmonary Disease (COPD)

OBJECTIVES: To investigate the humanistic and economic burden of severe COPD.

METHODS: A systematic literature review (SLR) was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. Embase^® and MEDLINE^® were searched via OvidSP^® for the period November 2021 to November 2023, supplemented by hand-searching of relevant conferences and literature.

RESULTS: 2,276 database records were identified; 44 studies included following full-text screening and six studies from hand-searches; 50 studies were included in total. The SLR revealed a substantial impairment in health-related quality of life (HRQoL), both physical and psychological, in severe COPD with a consistent decline as disease advanced. Pulmonary rehabilitation was effective, leading to significant improvements in HRQoL. Health state utility values showed a decrement with exacerbations, while adherence to treatment, particularly inhaler medications, improved outcomes. The economic burden of COPD was substantial, with direct healthcare costs increasing significantly with disease severity. For example, a cross-sectional Spanish study demonstrated an increase in mean annual direct medical costs per patient (2015 Euros) from €1,246 in stage I to €5,669 in stage IV (p<0.05). The same study showed no differences in mean annual per patient direct non-medical costs at early stages, however these costs were significantly higher in stage IV (€7,691) versus stage III (€3,507; p<0.05). Similar trends were observed in a retrospective study in the UK. Generally, hospitalisations and exacerbations were significant contributors to direct costs regardless of disease severity levels. Indirect costs also increased with increasing disease severity, with more sick days and premature retirement associated with very severe/severe versus mild COPD.

CONCLUSIONS: Our findings underscore the substantial impairment in HRQoL among severe COPD patients, and the need for interventions and treatment adherence to improve patient QoL and disease control. The economic burden of COPD is substantial, with direct costs and resource use increasing with disease severity.