Abstract: | BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity
and mortality worldwide. Comorbidities are often reported in patients with
COPD and may influence the cost of care. Yet, the extent by which
comorbidities affect costs remains to be determined.ObjectivesTo review, quantify and evaluate excess costs of comorbidities in COPD.MethodsUsing a systematic review approach, Pubmed and Embase were searched for
studies analyzing excess costs of comorbidities in COPD. Resulting studies
were evaluated according to study characteristics, comorbidity measurement
and cost indicators. Mark-up factors were calculated for respective excess
costs. Furthermore, a checklist of quality criteria was applied.ResultsTwelve studies were included. Nine evaluated comorbidity specific costs;
three examined index-based results. Pneumonia, cardiovascular disease and
diabetes were associated with the highest excess costs. The mark-up factors
for respective excess costs ranged between 1.5 and 2.5 in the majority of
cases. On average the factors constituted a doubling of respective costs in
the comorbid case. The main cost driver, among all studies, was inpatient
cost. Indirect costs were not accounted for by the majority of studies.
Study heterogeneity was high.ConclusionsThe reviewed studies clearly show that comorbidities are associated with
significant excess costs in COPD. The inclusion of comorbid costs and
effects in future health economic evaluations of preventive or therapeutic
COPD interventions seems highly advisable. |