Cost analysis of chronic obstructive pulmonary disease in a tertiary care setting in Taiwan

Background and objective: The prevalence of COPD in the Western Pacific is increasing. The present study determined the total direct health-care costs for the management of COPD patients with differing degrees of disease severity. The study also aimed to find the key cost drivers in the management of COPD. Methods: COPD patients were recruited from a tertiary care hospital during April 2002 and March 2003. One-year costs were identified by applying cost data to medical information obtained by review of medical records. Costs included those for medications, oxygen therapy, laboratory and diagnostic tests, clinic visits, emergency room visits and hospital stays. Results: There were 160 patients recruited. Patients were categorized by COPD severity: moderate A COPD (50 <= FEV(1)% < 80; n = 54), moderate B COPD (30 <= FEV(1)% < 50; n = 54) and severe COPD (FEV(1)% < 30; n = 52). Patients with moderate A, moderate B and severe COPD had an average of 0.82, 2.6 and 3.5 exacerbations per year, respectively. Average numbers of emergency room visits were 0.41 +/- 0.94, 1.20 +/- 1.39 and 1.73 +/- 2.44 per year in moderate A, moderate B and severe COPD patients, respectively. The mean total direct costs were New Taiwan dollars 288 825, 149 031 and 38 203 for severe COPD, moderate B COPD and moderate A COPD, respectively. The total annual cost was correlated with the disease severity. Hospitalization contributed the major portion of cost and also correlated with disease severity. Conclusions: There is a correlation between the cost of COPD and disease severity with hospitalization owing to disease exacerbation being a major contributor to cost. The keys to reducing health-care costs lie with reducing the frequency of exacerbations and the disease severity.