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PLoS One. 2015 Apr 13;10(4):e0123292. doi: 10.1371/journal.pone.0123292. eCollection 2015.

Excess costs of comorbidities in chronic obstructive pulmonary disease: a systematic review.

Author information

1
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany.
2
Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-Universität Marburg, University Medical Centre Giessen and Marburg (UGMLC), Member of the German Center for Lung Research (DZL), Marburg, Germany.
3
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany; Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany.

Abstract

BACKGROUND:

Chronic 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.

OBJECTIVES:

To review, quantify and evaluate excess costs of comorbidities in COPD.

METHODS:

Using 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.

RESULTS:

Twelve 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.

CONCLUSIONS:

The 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.

PMID:
25875204
PMCID:
PMC4405814
DOI:
10.1371/journal.pone.0123292
[Indexed for MEDLINE]
Free PMC Article

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