Costs of COPD exacerbations in a general population.

Background: Studies on costs of COPD exacerbations from general populations are scarce. Objectives: To compare direct costs (treatment-related) and indirect costs (productivity-related) associated with COPD in population based and hospital-recruited samples, and to estimate the components related to moderate and severe exacerbations. Methods: We performed 4 telephone interviews with 81 COPD cases and 132 controls from a population-based survey and 205 hospital-recruited COPD-patients. A moderate exacerbation was defined by use of antibiotics or corticosteroids due to respiratory disease, and severe exacerbations by hospitalisation due to respiratory disease. The sum of direct and indirect costs gave the total costs. Initial analyses compared costs across the three groups, and multivariate quantile regression estimated the costs attributed to exacerbations. Results: The crude, annual mean total disease-related costs were €26518, €15021, and €6740 per person for the patients, cases, and controls (p<0.001), respectively. In multivariate analyses exacerbations explained a majority of both direct and indirect costs of COPD. Severe exacerbations accounted for €28329 (95% CI 11467, 45192) of the total costs of population based COPD. For hospital-recruited COPD patients, both moderate and severe exacerbations were significant cost drivers accounting for €3034 (467, 5600) and €8527 (3912, 13141) of the total costs. Among hospital-recruited COPD patients, increasing GOLD-stage was also significantly associated with elevated costs. Conclusion: The annual total health-related costs for a hospital-recruited COPD-patient were nearly twice that of a general population-based COPD-case. The most important cost driver was severe exacerbations.