P181 Healthcare utilisation in chronic cough

Introduction Chronic cough is a common cause for medical consultations, and is associated with considerable physical and psychological morbidity. We investigated healthcare use and cost in chronic cough, and assessed its relationship with cough severity, health status, objective cough frequency (CF) and anxiety and depression. Methods Prospective study of consecutive patients with chronic cough from a specialist clinic who completed a cough severity visual analogue scale (VAS), cough-specific (Leicester Cough Questionnaire; LCQ) and general health status EuroQol EQ-5D-5L, Generalised Anxiety Disorder (GAD7), Patient Health Questionnaire (PHQ9) and 24-hour objective CF monitoring with Leicester Cough Monitor (LCM). Case notes were reviewed for cough specific healthcare use 12 months before and after the first cough clinic consultation. Resource use included general practitioner and hospital clinic visits, investigations and treatments. Unit costs for healthcare use were derived predominantly from National Health Service Reference Costs. Results 100 participants with chronic cough were recruited (69% female, median duration 3 years, mean age 58 years). The diagnoses of cough were unexplained (57%) refractory (27%) and other (16%). Cough severity, health status, anxiety severity, depression severity and CF were: median (IQR) VAS 59.5 (30.0–79.0) mm, mean (SD) LCQ 11.9 (4.0), EQ-5D-5L 0.846 (0.178), GAD7 2.78 (4.85), PHQ9 3.30 (5.47) and geometric mean (SD) CF 15.3 (2.5) coughs·hr-1, respectively. The mean total cost per individual for cough related healthcare utilisation was £1664.64. Diagnostic investigations were the largest contributor to cost (63%), followed by cough clinic consultations (25%). In multivariate analysis, anxiety (GAD7) and cough related health status (LCQ) were associated with increased cost (p=0.001 and 0.041 respectively). Discussion Chronic cough is associated with significant healthcare costs and these are largely due to diagnostic investigations and clinic consultations. The strongest predictors of costs were health status (LCQ) and anxiety. Further studies should investigate the optimal management protocols for patients with chronic cough. Funding for this study was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.