Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2008 Sep 30;39(10):547–555. [Article in Spanish] doi: 10.1157/13110735

Estimación de la morbilidad, el uso de recursos y los costes de los sujetos en tratamiento con bromuro de tiotropio para la enfermedad pulmonar obstructiva crónica en un ámbito poblacional español

Calculation of morbidity, use of resources and costs of patients treated with tiotropium bromide for copd in a spanish population

Antoni Sicras-Mainar a,⁎, Soledad Velasco-Velasco a, Josep Ramon Llopart-López a, Ruth Navarro-Artieda b, Luis De Haro-Martí b
PMCID: PMC7659490  PMID: 17949628

Abstract

Objective

To determine the co-morbidity and economic impact of treatment with tiotropium bromide (TB) for COPD, in a population cared for by Spanish primary care teams (PCTs) and specialist physicians, in the context of routine clinical practice.

Design

Retrospective multi-centre study.

Setting

Four PCTs and 2 urban hospitals.

Participants

Patients with COPD receiving regular treatment with TB, during 2004.

Main measurements

Age and sex, episodes of comorbidity, clinical parameters, resource use, and pharmacological groups. The costs model was established by differentiating semi-fixed from variable costs (pharmacy, tests, referrals) in the PCTs, as well as the visits, emergencies and hospital admissions occurring in the hospitals. A logistical regression analysis was made to correct the model. The costs were contrasted by analysis of covariance (ANCOVA), with the estimation of marginal means (Bonferroni adjustment).

Results

Of 900 patients with COPD, 14.3% (n=129) received treatment with TB (95% CI, 12.0%-16.6%). The mean episodes/patient/year was 2.1 (1.4) versus 1.8 (1.3) (NS), seriousness/severity 41.3% versus 26.3% (P =.001), defined daily dose (DDD) 5928.5 (9624.1) versus 6187.7 (12471.3) (NS) and number visits/patient/year 15.1 (9.4) versus 17.3(11.9) (P=.044). After adjustments for age and sex, TB use was associated with Diabetes Mellitus (OR=1.6; 95% CI, 1.0-2.5; P=.034) and severity of patients’ illness (OR=1.8; 95% CI, 1.2-2.8; P=.004). Quantification of unit cost/year was 2793.16 (3166.30) euros (3359.27 [3423.25] euros versus 2703.09 [3113.75] euros; P=.001). The adjusted patient cost/year was 2831.23 euros (SE, 217.32) with TB versus 2786.86 euros (SE, 88.53) without TB (NS).

Conclusions

TB is associated, as therapy complementing routine treatment, with the presence of Diabetes, and with the severity of the disease. The costs of COPD entail high resource consumption. The prescription of TB does not imply greater overall cost of the disease.

Key words: COPD, Tiotropium bromide, Resource use, Health costs

Bibliografía

  • 1.Celli B.R., MacNee B.R. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–946. doi: 10.1183/09031936.04.00014304. [DOI] [PubMed] [Google Scholar]
  • 2.Pauwels R.A., Buist A.S., Calverley P.M.A., Jenkins C.R., Hurd S.S. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163:1256–1276. doi: 10.1164/ajrccm.163.5.2101039. [DOI] [PubMed] [Google Scholar]
  • 3.Murray C.J., López A.D. Alternative projection of mortality by cause 1999-2020: Global Burden of Disease study. Lancet. 1997;349:1498–1504. doi: 10.1016/S0140-6736(96)07492-2. [DOI] [PubMed] [Google Scholar]
  • 4.Sánchez-Agudo L., Calatrava J.M., Carreras C. Estudio prospectivo de síntomas relacionados con la enfermedad pulmonar obstructiva crónica entre la población general. Resultados preliminares. Arch Bronconeumol. 1992;28:15. [Google Scholar]
  • 5.Brotons B., Pérez J.A., Sánchez-Toril F., Soriano S., Hernández J., Belenguer J.L. Prevalencia de la enfermedad pulmonar obstructiva crónica y del asma. Estudio transversal. Arch Bronconeumol. 1994;30:149–152. doi: 10.1016/s0300-2896(15)31109-1. [DOI] [PubMed] [Google Scholar]
  • 6.Marco L., Martín J.C., Corres M., Luque R., Zubillaga G. Enfermedad pulmonar obstructiva crónica en la población general. Estudio epidemiológico realizado en Guipúzcoa. Arch Bronconeumol. 1998;34:23–27. [PubMed] [Google Scholar]
  • 7.Jaén A., Ferrer A., Ormaza I., Rué M., Domingo C.H., Marín A. Prevalencia de bronquitis crónica, asma y obstrucción al flujo aéreo en una zona urbano-industrial de Cataluña. Arch Bronconeumol. 1999;35:122–128. doi: 10.1016/s0300-2896(15)30290-8. [DOI] [PubMed] [Google Scholar]
  • 8.Sobradillo V., Miravitlles M., Jiménez C.A., Gabriel R., Viejo J.L., Masa J.F. Estudio IBERPOC en España: prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo. Arch Bronconeumol. 1999;35:159–166. doi: 10.1016/s0300-2896(15)30272-6. [DOI] [PubMed] [Google Scholar]
  • 9.Sobradillo V., Miravitlles M., Gabriel R., Jiménez C., Villasante C., Masa J.F. Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC Multicentre Epidemiological Study. Chest. 2000;118:981–989. doi: 10.1378/chest.118.4.981. [DOI] [PubMed] [Google Scholar]
  • 10.Miravitlles M., Fernández I., Guerrero T., Murio C. Desarrollo y resultados de un programa de cribado de la EPOC en Atención Primaria. El proyecto PADOC. Arch Bronconeumol. 2000;36:500–505. doi: 10.1016/s0300-2896(15)30110-1. [DOI] [PubMed] [Google Scholar]
  • 11.Dal Negro R., Berto P., Tognella S., Quareni L. Global Outcomes in Lung Disease Study Group. Cost-of-illness of lung disease in the TriVeneto Region, Italy: the GOLD Study. Monaldi Arch Chest Dis. 2002;57:1–9. [PubMed] [Google Scholar]
  • 12.Barberá J.A., Peces-Barba G., Agustí A.G.N., Izquierdo J.L., Monsó E., Montemayor T. Guía clínica para el diagnóstico y el tratamiento de la enfermedad pulmonar obstructiva crónica. Normativa SEPAR. Arch Bronconeumol. 2001;37:297–316. doi: 10.1016/s0300-2896(01)75074-0. [DOI] [PubMed] [Google Scholar]
  • 13.Grupo de Trabajo-Conferencia de Consenso sobre EPOC Enfermedad pulmonar obstructiva crónica. Arch Bronconeumol. 2003;39:5–6. [Google Scholar]
  • 14.Escarrabill J. Costes sanitarios de la enfermedad pulmonar obstructiva crónica (EPOC) Arch Bronconeumol. 2003;39:435–436. doi: 10.1016/s0300-2896(03)75424-6. [DOI] [PubMed] [Google Scholar]
  • 15.Masa J.F., Sobradillo V., Villasante C., Jiménez-Ruiz C.A., Fernández-Fau L., Viejo J.L. Costes de la EPOC en España. Estimación a partir de un estudio epidemiológico poblacional. Arch Bronconeumol. 2004;40:72–79. doi: 10.1016/s1579-2129(06)60198-5. [DOI] [PubMed] [Google Scholar]
  • 16.Miravitlles M., Murio C., Guerrero T., Gisbert R. Costs of chronic bronchitis and COPD. A one year follow-up study. Chest. 2003;123:784–791. doi: 10.1378/chest.123.3.784. [DOI] [PubMed] [Google Scholar]
  • 17.Jansson S.A., Andersson F., Borg S., Ericsson A., Jonson E., Lundbäck B. Costs of COPD in Sweden according to disease severity. Chest. 2002;122:1994–2002. doi: 10.1378/chest.122.6.1994. [DOI] [PubMed] [Google Scholar]
  • 18.Murtagh E., O’Neill C., McAllister D., Kee F., Macmahon J., Heaney L.G. A cross-sectional comparison of direct medical care costs among COPD and asthma patients living in the community in Northern Ireland. Treat Respir Med. 2006;5:495–501. doi: 10.2165/00151829-200605060-00012. [DOI] [PubMed] [Google Scholar]
  • 19.Verdaguer Munujos A., Peiró S., Librero J. Variabilidad en la utilización de recursos hospitalarios en pacientes con enfermedad pulmonar obstructiva crónica. Arch Bronconeumol. 2003;39:442–448. doi: 10.1016/s0300-2896(03)75426-x. [DOI] [PubMed] [Google Scholar]
  • 20.Anzueto A. Clinical course of chronic obstructive pulmonary disease: review of therapeutic interventions. Am J Med. 2006;119:46–53. doi: 10.1016/j.amjmed.2006.08.007. [DOI] [PubMed] [Google Scholar]
  • 21.Jaén-Díaz J.I., De Castro Mesa C., Cordero García B., Gontán García-Salamanca M.J., Callejas Pérez S., López de Castro F. Efectividad del tratamiento con bromuro de tiotropio en pacientes con enfermedad pulmonar obstructiva crónica. Med Clin (Barc) 2005;124:1–3. doi: 10.1157/13070433. [DOI] [PubMed] [Google Scholar]
  • 22.Vincken W., Van Noord J.A., Greefhorst A.P., Bantje T.A., Kesten S., Korducki L. Improved health outcomes in patients with COPD during 1 yr's treatment with tiotropium. Eur Respir J. 2002;19:209–216. doi: 10.1183/09031936.02.00238702. [DOI] [PubMed] [Google Scholar]
  • 23.Brusasco V., Hodder R., Miravitlles M., Korducki L., Towse L., Kesten S. Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD. Thorax. 2003;58:399–404. doi: 10.1136/thorax.58.5.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Lamberts H., Wood M. Clasificación de razones de consulta. Masson/SG; Barcelona: 1990. Clasificación internacional de la atención primaria CIAP-2. [Google Scholar]
  • 25.Guidelines for ATC classification. Oslo: Nordic Collaborating Centre for Drug Statistics Methodology, 1991.
  • 26.Orden de la Generalitat de Catalunya de 22 de diciembre de 1995. Diari Oficial de la Generalitat de Catalunya. 1995; 2148:9689-90.
  • 27.García Cardona F., Molins Pérez G., Farré Pradell J. La contabilidad de costes en atención primaria y cartera de servicios. Aten Primaria. 1995;16:141–145. [PubMed] [Google Scholar]
  • 28.Sackett D., Rosenberg W., Gray J., Haynes R.B. Richardson WS. Evidence based medicine: what it is and what it is’t. BMJ. 1996;312:71–72. doi: 10.1136/bmj.312.7023.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Miravitlles M., De la Roza C., Naberan K., Lamban M., Gobartt E., Martín A. Problemas con el diagnóstico de la EPOC en atención primaria. Arch Bronconeumol. 2006;42:3–8. doi: 10.1016/s1579-2129(06)60106-7. [DOI] [PubMed] [Google Scholar]
  • 30.Barr R.G., Bourbeau J., Camargo C.A., Ram F.S. Tiotropium for stable chronic obstructive pulmonary disease: a meta-analysis. Thorax. 2006;61:854–862. doi: 10.1136/thx.2006.063271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.D'Souza A.O., Smith M.J., Miller L.A., Kavookjian J. An appraisal of pharmacoeconomic evidence of maintenance therapy for COPD. Chest. 2006;129:1693–1708. doi: 10.1378/chest.129.6.1693. [DOI] [PubMed] [Google Scholar]
  • 32.Adams S.G., Anzueto A., Briggs D.D., Jr, Menjoge S.S., Kesten S. Tiotropium in COPD patients not previously receiving maintenance respiratory medications. Respir Med. 2006;100:1495–1503. doi: 10.1016/j.rmed.2006.03.034. [DOI] [PubMed] [Google Scholar]
  • 33.Miravitlles M. La calidad de vida en los pacientes con enfermedad pulmonar obstructiva crónica: criterios de cuantificación y repercusiones terapéuticas. Rev Clin Esp. 2005;205:439–442. doi: 10.1157/13079073. [DOI] [PubMed] [Google Scholar]
  • 34.Casaburi R., Mahler D.A., Jones P.W., Wanner A., San Pedro G., Zuwallack R.L. A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J. 2002;19:217–224. doi: 10.1183/09031936.02.00269802. [DOI] [PubMed] [Google Scholar]
  • 35.Donohue J.F., Van Noord J.A., Bateman E.D., Langley S.J., Lee A., Witek T.J., Jr A 6-month placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest. 2002;122:47–55. doi: 10.1378/chest.122.1.47. [DOI] [PubMed] [Google Scholar]
  • 36.Calverley P., Pawels R., Vestbo J., Jones P., Pride N., Gulsvik A. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 2003;361:449–456. doi: 10.1016/S0140-6736(03)12459-2. [DOI] [PubMed] [Google Scholar]
  • 37.Szafranski W., Cukier A., Ramírez A., Menga G., Sansores R., Nahabedian S. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J. 2003;21:74–81. doi: 10.1183/09031936.03.00031402. [DOI] [PubMed] [Google Scholar]
  • 38.Baloira-Villar A., Vilariño-Pombo C. Eficacia broncodilatadora de la asociación de salmeterol y tiotropio en pacientes con EPOC. Arch Bronconeumol. 2005;41:130–134. doi: 10.1016/s1579-2129(06)60413-8. [DOI] [PubMed] [Google Scholar]
  • 39.García-Ruiz A.J., Leiva-Fernández F., Martos-Crespo F. Análisis del coste-eficacia del tiotropio frente al ipratropio y salmeterol. Arch Bronconeumol. 2005;41:242–248. doi: 10.1016/s1579-2129(06)60217-6. [DOI] [PubMed] [Google Scholar]
  • 40.Izquierdo J.L., De Miguel J. Economic impact of pulmonary drugs on direct costs of stable chronic obstructive pulmonary disease. Journal of COPD. 2004;1:215–223. doi: 10.1081/copd-120039809. [DOI] [PubMed] [Google Scholar]
  • 41.Izquierdo-Alonso J.L., Arroyo-Espliguero R. EPOC y riesgo cardiovascular. Arch Bronconeumol. 2005;41:410–412. doi: 10.1016/s1579-2129(06)60254-1. [DOI] [PubMed] [Google Scholar]
  • 42.Sin D.D., Man S.F. Chronic obstructive pulmonary disease: a novel risk factor for cardiovascular disease. Can J Physiol Pharmacol. 2005;83:8–13. doi: 10.1139/y04-116. [DOI] [PubMed] [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES