The morbidity and economic costs associated with COPD

The morbidity and economic costs associated with COPD are
high, largely unrecognised, and more than twice those from
asthma. The impact on quality of life is particularly high in
patients with frequent exacerbations, and even patients with
mild COPD have an impaired quality of life.
Since the mid-1990s, emergency admissions for COPD have
increased by at least 50%, so that in 2002-3 there were 110 000
hospital admissions for an exacerbation of COPD in England,
accounting for 1.1 million bed days. At least 10% of emergency
admissions to hospital are as a consequence of COPD, and this
proportion is even greater during the winter. Most admissions
are of people older than 65 years with advanced disease, who
are often admitted repeatedly and use a disproportionate
amount of resources. About 25% of patients with COPD
diagnosed need admission to hospital, with some 15% of
patients being admitted each year.
The impact in primary care is even greater, with 86% of care
being provided exclusively by primary care. An average general
practitioner’s list will contain some 200 patients with COPD
(even more in areas of social deprivation), although not all will
have it diagnosed. On average, patients with COPD make six or
seven visits annually to their general practitioner. Each patient
costs the UK economy an estimated £1639 annually, equating
to a national burden of £982m (€1450, $1741m). For each
patient, annual direct costs to the NHS are £819, with 54% of
this being due to hospital admissions and 19% due to drug
treatment. COPD results in further costs to society in that
roughly 40% of UK patients are below retirement age, and the
disease prevents about 25% from working and reduces the
capacity to work in a further 10%. Annual indirect costs of
COPD have been estimated at £820 per patient and consist of
the cost of disability, absence from work, premature mortality,
and the time caregivers miss work.