GOLD guidelines adherence impact on the NHS budget

OBJECTIVE: Aim of this study was the evaluation of the adherence level to GOLD guidelines for the COPD patients' treatment in the Italian GPs setting, observing the time trend on ICS therapies' pharmacoutilization, specifically in mild and moderate COPD patients, which is considered inappropriate by GOLD guidelines. Moreover, a pharmacoeconomic analysis has been implemented in order to evaluate the economical burden of the improper management of COPD. METHODS: The retrospective GPs database study has analyzed patients with at least one diagnosis of COPD during the periods January 2005 - December 2008 (Cohort 1) and January 2009 - December 2011 (Cohort 2), who had a reported value of VEMS, at least one prescription of a drug from ATC R03 class within two months from the date of spirometric exam and aged 40 or more. Disease severity has been defined according to 2008 GOLD guidelines. Comparison between the cohorts has been implemented to verify possible variations in guideline adherence. Furthermore, an economical analysis has been developed in order to highlight saves obtained by following GOLD guidelines and the total inappropriate therapies' costs. RESULTS: The first cohort involved 2,103 COPD patients, while the second cohort included 1,647 subjects. Reduction of ICS therapies has been shown between the two cohorts, with a decrease of 8.4% for mild patient and 1.6% for moderate patients; considering all the disease severities, the reduction was about 4%. Pharmacoeconomic analysis on mild and moderate patients has pointed out that about 50% of the total ICS treatments (814,692 (sic) on 1,658,164 (sic)) is related to the ICS element, and so considered inappropriate costs. CONCLUSION: Economic differences between the two periods have highlighted a minor mean costs for Cohort 2, underlining an improvement in the adherence to the GOLD guidelines in the last period.