Delivering Cost-effective Care for COPD in the USA

Recent Progress and Current Challenges

Ian M Breunig; Fadia T Shaya; Steven M Scharf


Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(6) 

In This Article

Abstract and Introduction


Chronic obstructive pulmonary disease (COPD) imposes a significant and growing economic burden on the US health care system. A brief exploration of reviews on the therapeutic management of COPD reveals a range of pharmacologic and nonpharmacologic options for reducing deleterious and costly exacerbations. Consensus is that both forms of therapy provide the greatest benefit to all patients. However, prescribing physicians must account for availability of resources and patients' ability to pay, as well as patient response and their likely persistence or adherence to recommended therapies. The ongoing challenge is to overcome barriers to comprehensive, real-world economic evaluations in order to establish the most cost-effective mix of therapies for every patient in the heterogeneous COPD population. Only then can evidence-based guidelines be translated into the most cost-effective delivery of care.


Chronic obstructive pulmonary disease (COPD) is actually a spectrum of pathologic conditions ranging from airways inflammation (chronic bronchitis) to destruction of peripheral lung tissue (emphysema), with most patients having aspects of both pathologic types. COPD is a common respiratory condition characterized by airflow limitation that is both progressive and associated with an abnormal pulmonary and systemic inflammatory response related to exposure of the lungs to noxious particles or gases.[1] Prolonged exposure to tobacco smoke is the greatest risk factor for development of COPD, other risk factors being occupational toxins, indoor and outdoor air pollutants and childhood infections.[1] COPD is a leading cause of mortality and morbidity and its prevalence is increasing worldwide.[1] In the USA alone, an estimated 14.8 million people were diagnosed with COPD in 2010,[2] and because of various challenges to screening for COPD, nearly as many affected individuals may be undiagnosed.[2–4] In 2008, the CDC moved Chronic Lower Respiratory Disease (which includes COPD and asthma) from the fourth to the third leading cause of death in the USA.[5] COPD imposes a substantial economic and social burden due to its prevalence and its reduction in functional status. COPD is associated with reduced workforce participation, increased disability time and lower employment productivity[6–8] and is responsible for estimated indirect costs of US$20.4 billion in the USA in 2010.[9] Direct costs of COPD care were an estimated US$29.5 billion. Hospital care was projected to account for nearly half (US$13.2 billion) of all direct costs of COPD, whereas outpatient prescription drugs accounted for close to 20%, physician costs 19%, nursing home care 12.5% and home healthcare 4%.[9]

COPD is often accompanied by exacerbations of respiratory symptoms which are not only associated with significant impairments to quality of life but often require hospitalization.[10] In fact, the economic burden of COPD exacerbations account for up to 70% of all direct costs associated with COPD and most of these costs are attributed to inpatient admissions.[11–19] Exacerbations become more frequent and severe with increasing severity of airflow obstruction[1,10,20] and in turn, the costs increase with the severity of the exacerbation.[21] Thus, reducing the frequency and severity of COPD exacerbations not only reduces the personal detriment to the patients but also hospitalizations, thereby significantly reducing the burden of COPD on health care systems.[15,18,22]

The discussion herein briefly highlights recent progress in the establishment of evidence-based therapies for managing COPD exacerbations and healthcare utilization. It goes on to address the present challenges to integrating recommended therapies into real-world practice in the USA. Several systematic and nonsystematic reviews, as well as some independent studies, are referenced below. All articles were obtained from Pubmed (MEDLINE) and the list is certainly not exhaustive of the abundant research recently published on the management of COPD.[23]