Table 3.
Mean healthcare utilisation (HU), unit costs, and mean (SE) total costs of maintenance therapy and exacerbations from the NHS perspective for Spain in euros at the 2005 value (HU healthcare utilisation, RP respiratory physician, GP general practitioner, ICU intensive care unit, exa exacerbation)
| Maintenance therapy |
Unit costs | Moderate COPD | Severe COPD | Very severe COPD | |||
|---|---|---|---|---|---|---|---|
| HU per patient per year | Total costs | HU per patient per year | Total costs | HU per patient per year | Total costs | ||
| Visit RP in hospital | 79.85 | 0.27 | 22 (1) | 0.44 | 35 (2) | 0.63 | 50 (3) |
| Visit RP outside hospital | 23.77 | 0.38 | 9 (1) | 0.57 | 14 (1) | 0.65 | 15 (1) |
| Visit GP | 8.35 | 2.59 | 22 (1) | 2.88 | 24 (1) | 3.27 | 27 (1) |
| Thorax X-ray | 19.67 | 1.03 | 20 (1) | 1.18 | 23 (1) | 1.49 | 29 (1) |
| ECG | 22.53 | 0.80 | 18 (1) | 0.87 | 20 (1) | 1.15 | 26 (1) |
| Spirometry | 40.63 | 0.55 | 22 (1) | 0.66 | 27 (1) | 0.92 | 37 (2) |
| Blood analyses | 19.67 | 1.41 | 28 (1) | 1.43 | 28 (1) | 1.58 | 31 (1) |
| Blood gases | 27.25 | 0.33 | 9 (1) | 0.56 | 15 (1) | 0.67 | 18 (1) |
| Influenza vaccination | 5.47 | 0.48 | 3 (1) | 0.64 | 4 (1) | 0.72 | 4 (1) |
| Theophylline | 0.18 | 122.06 | 22 (8) | 161.77 | 30 (4) | 159.07 | 29 (5) |
| Mucolytics | 0.30 | 39.74 | 11 (3) | 48.31 | 14 (2) | 80.60 | 24 (4) |
| Oral corticosteroids | 0.29 | 21.54 | 6 (3) | 23.73 | 7 (1) | 78.48 | 23 (6) |
| Inhaled corticosteroids | 0.61 | 224.84 | 138 (12) | 224.84 | 138 (15) | 292.00 | 179 (22) |
| Oxygen | 3.73 | 21.32 | 79 (14) | 44.26 | 165 (30) | 77.87 | 290 (52) |
| Other | 20 (3) | 44 (4) | 34 (5) | ||||
| Total costs per patient per year | 430 (24) | 587 (34) | 818 (58) | ||||
| Exacerbations | Unit costs | Non-severe exacerbation | Severe exacerbation | Study medication costs per day | |||
|---|---|---|---|---|---|---|---|
| HU per exa | Total costs | HU per exa | Total costs | ||||
| ICUa | 1,284 | – | – | 0.29 | 374 (291) | Tiotropium | 1.80 |
| Non-ICUa | 368 | – | – | 4.16 | 1,529 (307) | Salmeterol | 1.20 |
| Emergency room | 115 | – | – | 0.94 | 108 (11) | Ipratropium | 0.19 |
| Visit GP | 8.35 | 1.64 | 14 (1) | 1.00 | 8 (3) | ||
| Visit RP in hospital | 79.85 | – | – | 0.52 | 42 (10) | ||
| Antibioticsb | 5.00 | 11.02 | 55 (7) | 7.52 | 38 (7) | ||
| Oral corticosteroidsb | 0.29 | 2.69 | 1 (1) | 4.98 | 1 (1) | ||
| Inhaled corticosteroidsb | 0.61 | 7.01 | 4 (1) | 3.71 | 2 (1) | ||
| Oxygenb | 3.73 | 2.05 | 8 (3) | 5.32 | 20 (2) | ||
| Other | 1 (1) | 1 (1) | |||||
| NHS sick leave benefitc | s74.09 | 13 (2) | |||||
| Total costs per exacerbation | 83 (7) | 2,136 (425) | |||||
For medications and oxygen HU is expressed in number of days during which the medication or oxygen was used
aOf all severe exacerbations 52% required hospital admission. Of those, 14% were to the ICU. The length of stay on ICU is 4 days, and the length of stay on non-ICU is 8 days. Hence, 0.52 × 0.14 × 4 = 0.29 and 0.52 × 8 = 4.16
bOnly medications prescribed in ambulatory settings. Costs of medications administered in hospital and at emergency rooms are included in costs of hospital stay/emergency room visit
cAverage labour costs per day in Spain are €74.09. Of Spanish COPD patients, 33.2% have paid employment; 0.332 × €74.09 = €24.60. The NHS covers 60% of these labour costs during days 16–20 of the sick leave episode and 75% from day 21 onwards. Of severe exacerbations, 7% are associated with sick leave longer than 15 days. The duration of these absence spells is 26 days. So, (5 × 0.6 × €24.60 + 6 × 0.75 × €24.60) × 0.07 = €13.43