, Volume 19, Issue 3, pp 245–254 | Cite as

Economic Burden of Chronic Obstructive Pulmonary Disease

Impact of New Treatment Options
  • Mitchell FriedmanEmail author
  • Daniel E. Hilleman
Review Article


The incidence, morbidity and mortality of chronic obstructive pulmonary disease (COPD) is rising throughout the world. The total economic cost of COPD in the US in 1993 was estimated to be over $US15.5 billion, with $US6.1 billion for hospitalisation, $US4.4 billion for physician and other fees, $US2.5 billion for drugs, $US1.5 billion for nursing home care and $US1.0 billion for home care. Office visits, hospital outpatient visits and emergency department visits accounted for 17.3% of the direct costs for COPD in the US. When stratified by severity, COPD treatment costs strongly correlate with disease severity. The American Thoracic Society, the European Respiratory Society and the British Thoracic Society have developed guidelines for the pharmacological treatment of COPD. However, the guidelines establish inhaled bronchodilators (anticholinergic agents and β2-adrenergic agonists) as the mainstay of therapy for patients with COPD. The guidelines were not based on cost analyses and thus are not a priori cost-effective guidelines.

Since the publication of these guidelines, several new pharmacological products have been approved for use in patients with COPD including a combination of an anticholinergic and selective β2-adrenergic agonist [ipratropium/salbutamol (albuterol)] and a long-acting β2-adrenergic agonist (salmeterol). Both products are effective bronchodilators in COPD. The purpose of this report is to place these new agents in an updated pharmacological guideline scheme, utilising recently published data on clinical efficacy as well as pharmacoeconomics. The annualised healthcare costs were computed to be $US788/patient/year for the combination ipratropium/salbutamol inhaler and $US1059/patient/year for salmeterol (1999 values). Based upon an improved understanding of the complexity of COPD, the response of patients to newer bronchodilators (given individually or in combination), and recent pharmacoeconomic data for COPD treatment, a new treatment algorithm with associated costs is proposed. The use of an algorithm, based on medical and pharmacoeconomic data, will improve lung function in patients with COPD, improve patient satisfaction (e.g. quality of life, dyspnoea) and outcomes (e.g. exacerbations). It will also result in a positive effect on healthcare costs.


Chronic Obstructive Pulmonary Disease Salbutamol Salmeterol Ipratropium American Thoracic Society 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Singh GK, Matthews TJ, Clarke SC, et al. Annual summary of births, marriages, divorces and deaths: United States, 1994; monthly vital statistics report. Vol. 43. No. 13. Hyattsville (MD): National Center for Health Statistics, 1994Google Scholar
  2. 2.
    Hilleman DE, Dewan N, Malesker M, et al. Pharmacoeconomic evaluation of COPD. Chest 2000; 118 (5): 1278–85PubMedCrossRefGoogle Scholar
  3. 3.
    National Heart, Lung, and Blood Institute. Morbidity & mortality: 1998 chartbook on cardiovascular, lung, and blood diseases. Hyattsville (MD): US Department of Health and Human Services, Public Health Service, 1998 OctGoogle Scholar
  4. 4.
    Center for Disease Control and Prevention/National Center for Health Statistics. Discharge summary annual survey 1998. Hyattsville (MD): Center for Disease Control and Prevention, 1998Google Scholar
  5. 5.
    Benson V, Marano MA. Current estimates from the National Health Interview Survey, 1995. National Center for Health Statistics. Vital Health Stat 1998; 10 (199): 1–428Google Scholar
  6. 6.
    American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152: S78–S121Google Scholar
  7. 7.
    Gross NJ. COPD: a disease of reversible airflow obstruction. Am Rev Respir Dis 1986; 133: 725–6PubMedGoogle Scholar
  8. 8.
    Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anti-cholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994; 272: 1497–505PubMedCrossRefGoogle Scholar
  9. 9.
    Siafakis NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 1995; 8: 1398–420CrossRefGoogle Scholar
  10. 10.
    COPD Guideline Group of the Standards of Care of the British Thoracic Society. Thorax 1997; 52 Suppl. 5: S1–S28Google Scholar
  11. 11.
    Braun S. A comparison of the effect of ipratropium and albuterol in the treatment of chronic obstructive airway disease. Arch Intern Med 1989; 149: 544–7PubMedCrossRefGoogle Scholar
  12. 12.
    Mahler DA, Donohue JF, Barbee RA, et al. Efficacy of salmeterol xinafoate in the treatment of COPD. Chest 1999; 115: 957–65PubMedCrossRefGoogle Scholar
  13. 13.
    Friedman M, Witek Jr TJ, Serby CW, et al. Pharmacoeconomic evaluation of a combination of ipratropium plus albuterol compared to ipratropium alone and albuterol alone in chronic obstructive pulmonary disease. Chest 1999; 115: 635–41PubMedCrossRefGoogle Scholar
  14. 14.
    Combivent Inhalation Aerosol Study Group. In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone: an 85-day multicenter trial. Chest 1994; 105: 1411–9CrossRefGoogle Scholar
  15. 15.
    Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155: 1283–9PubMedGoogle Scholar
  16. 16.
    Mahler DA, Jones PW. Measurement of dyspnea and quality of life in advanced lung disease. Clin Chest Med 1997; 18 (3): 457–69PubMedCrossRefGoogle Scholar
  17. 17.
    Anthonisen NR, Manfreda J, Warren C, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204PubMedGoogle Scholar
  18. 18.
    Price-Check PC: version 2.16 [CD-ROM]. St Louis (MO): Medi-Span, 1998Google Scholar
  19. 19.
    Price-Check PC: version 2.16 [CD-ROM]. St Louis (MO): Medi-Span, 1999Google Scholar
  20. 20.
    Gross NJ, Skorodin MS. Anticholinergic, antimuscarinic bronchodilators. Am Rev Respir Dis 1984; 129: 856–70PubMedGoogle Scholar
  21. 21.
    Rennard SI, Serby CW, Ghafouri M, et al. Extended therapy with ipratropium is associated with improved lung function in COPD: a retrospective analysis of data from seven clinical trials. Chest 1996; 110: 62–70PubMedCrossRefGoogle Scholar
  22. 22.
    Campbell SC, Auerbach D, Boyars M, et al. For COPD, a combination of ipratropium bromide and albuterol sulfate is more effective than albuterol base. Arch Intern Med 1999; 159: 156–60PubMedCrossRefGoogle Scholar
  23. 23.
    Gross NJ, Petty TL, Friedman M, et al. Dose-response to ipratropium as a nebulized solution in patients with chronic obstructive pulmonary disease: a three-center study. Am Rev Respir Dis 1989; 139: 1188–91PubMedGoogle Scholar
  24. 24.
    Niser NM, Walshaw JE, Earis MG, et al. Assessment of reversibility of airway obstruction in patients with chronic airways obstruction. Thorax 1990;: 190–4Google Scholar
  25. 25.
    Calverley PMA. Inhaled corticosteroids are beneficial in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 341–2PubMedGoogle Scholar
  26. 26.
    Barnes PJ. Inhaled corticosteroids are not beneficial in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 342–4PubMedGoogle Scholar
  27. 27.
    Burge PS, Calverley PMA, Jones PW, et al. Randomised, double-blind, placebo controlled study of fluticasone propianate in patients with moderate to severe chronic obstructive disease: the ISOLDE trial. BMJ 2000; 320: 1297–303PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Section of Pulmonary Disease, Critical Care Medicine, and Environmental MedicineTulane University Medical Center, School of MedicineNew OrleansUSA
  2. 2.Department of Pharmacy PracticeCreighton University School of Pharmacy and Allied Health ProfessionsOmahaUSA

Personalised recommendations