OBJECTIVES

: A recent publication has shown the prevalence of chronic obstructive pulmonary disease (COPD) in China is higher than previously thought (13.7%). Therefore, economic burden is also expected to be higher, particularly for COPD patients at risk for exacerbations. Long-acting inhaled controller therapy (LAICT) reduces the risk of exacerbations in COPD. In China, most COPD patients are not chronically treated with LAICT. We estimated the number of exacerbations and deaths avoided and potential cost savings by optimizing treatment with LAICT in COPD patients hospitalized for an exacerbation in China.

METHODS

: A 2 health states (alive-dead) Markov model with 1-month cycles and 12-month time horizon was developed. After discharge following a hospitalized (=severe) exacerbation, patients are at risk for a moderate/severe (fatal-non fatal) exacerbation or death during each cycle. The current scenario in which 38.5% of patients are treated with LAICT post-discharge was compared to a scenario in which all patients were treated. Average number of exacerbations per patient per year (1.21), risk reduction with LAICT (20-30%), exacerbation hospitalization rate (±17%), case fatality, monthly mortality, and the cost of an exacerbation requiring either inpatient or outpatient treatment were obtained from literature.

RESULTS

: Based on the prevalence of COPD in China, the annual estimated number of patients hospitalized for an exacerbation was 8.16 million. Applying the above assumptions, it was estimated that 1.69 million exacerbations and 7,318 deaths could be avoided annually with optimized treatment, leading to cost savings of 6.4 billion CNY. The most sensitive factor in the model was the exacerbation hospitalization rate. Other literature sources show a hospitalization rate of up to 50%, which would increase the number of deaths avoided and costs savings by a factor of 3.

CONCLUSIONS

: Optimizing post-hospitalization management of COPD patients in China could lead to considerable savings for payers and reduced patient burden.