Direct Costs of Treatment of COPD in a German Sickness Fund

OBJECTIVES: The study aims at investigating into the resource utilization of COPD patients related to severity of disease by analysing the cost due to outpatient drug prescriptions, remedies, and medical devices as well as hospitalizations. METHODS: Claims data from a German sickness fund for the year 2003 with 1.5 million beneficiaries were used. Beneficiaries 45 years of age or older were identified as COPD patients by a combination of diagnostic and drug prescription data. Patients were allocated to COPD stages as defined by the GOLD guideline. Cost data were extracted from claims files. Hospitalization costs were estimated based on average costs per-day. RESULTS: n=38,469 beneficiaries were identified as COPD patients. Average costs amounted to 633 Euro per patient in 2003 (50% drug prescriptions, 18% hospital care, 6% remedies, 5% medical devices). 65% of patients were at risk or had a mild disease (GOLD 0/1), 11% had a moderate disease (GOLD 2), 22% had a severe disease (GOLD 3) and 1% had a most severe COPD (GOLD 4: patients having received oxygene therapy). GOLD 0/1 patients caused average costs of 199 Euro; GOLD 2, GOLD 3, and GOLD 4 patients caused costs of 849 Euro, 1,635 Euro, and 5,426 Euro, respectively. While drug prescription costs accounted for the highest share for GOLD 0/1, 2, and 3 patients, costs of hospitalization were higher than drug costs for GOLD 4 patients. The average length of hospital stay for GOLD 0/1, 2 and 3 patients was between 12,8 and 13,6 days. An increase could be observed for GOLD 4 patients with an average length of stay of 15,9 days. CONCLUSION: Direct costs of COPD rise notably by increasing severity of illness. Costs observed are within a plausible range for Germany. International studies show strong variations of the shares of cost categories among countries: higher shares of hospitalization costs than in our study are reported for the U.S., Canada, Spain, and Italy; lower hospitalization costs were found in France and in the Netherlands.