Implications of chronic obstructive pulmonary disease (COPD) on patients’ health status: A western view

SummaryAimTo assess and compare health status among chronic obstructive pulmonary disease (COPD) patients presenting for treatment in six countries and in two healthcare settings using a generic health status instrument.MethodsA population based cross-sectional survey was conducted among 2703 patients and their physicians (1381 in primary and 1322 in specialty care) in five EU countries and the USA. Information was collected on demographic and clinical characteristics, exacerbations and health status estimated using EQ-5D.ResultsThe mean EQ-5D score for COPD patients was similar between primary and specialty settings in all countries except Italy. Approximately, half of the patients indicated some impairment in health status on mobility, usual activities, pain/discomfort and anxiety/depression domains of EQ-5D. Approximately, 5% of patients in EU countries except UK had health status valued as worse than death based on valuations of the general population. Patients suffering from severe breathlessness, experiencing ⩾3 exacerbations in the previous year, categorised as severe according to GOLD criteria, and experiencing day-time and night-time symptoms had significantly impaired health status.ConclusionCOPD patients classified as moderate/severe in clinical practice have worse health status compared to mild patients. This impairment is similar in primary and specialty setting across western countries

Continuing to Confront COPD International Patient Survey:Economic Impact of COPD in 12 Countries

BACKGROUND:The Continuing to Confront COPD International Patient Survey estimated the prevalence and burden of COPD across 12 countries. Using data from this survey we evaluated the economic impact of COPD. METHODS:This cross-sectional, population-based survey questioned 4,343 subjects aged 40 years and older, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. Direct cost measures were based on exacerbations of COPD (treated and those requiring emergency department visits and/or hospitalisation), contacts with healthcare professionals, and COPD medications. Indirect costs were calculated from work loss values using the Work Productivity and Activity Impairment scale. Combined direct and indirect costs estimated the total societal costs per patient. RESULTS:The annual direct costs of COPD ranged from $504 (South Korea) to$9,981 (USA), with inpatient hospitalisations (5 countries) and home oxygen therapy (3 countries) being the key drivers of direct costs. The proportion of patients completely prevented from working due to their COPD ranged from 6% (Italy) to 52% (USA and UK) with 8 countries reporting this to be ≥20%. Total societal costs per patient varied widely from $1,721 (Russia) to$30,826 (USA) but a consistent pattern across countries showed greater costs among those with increased burden of COPD (symptoms, health status and more severe disease) and a greater number of comorbidities. CONCLUSIONS:The economic burden of COPD is considerable across countries, and requires targeted resources to optimise COPD management encompassing the control of symptoms, prevention of exacerbations and effective treatment of comorbidities. Strategies to allow COPD patients to remain in work are important for addressing the substantial wider societal costs

Development and validation of a patient medication risk reduction behavior scale and application in a managed care population

The purpose of this study was to develop an instrument for assessing levels of patient medication risk reduction behaviors and apply that instrument to determine the extent to which patients currently engage in those behaviors. Instrument developed also was used to assess effects of a patient safety education program, designed to educate patients about these behaviors and encourage their participation in managing their medications. An instrument for measuring levels of patient medication risk reduction behaviors was developed based on behaviors identified by national experts as reducing risks. The survey instrument was mailed to 4,000 individuals, 2,000 each in intervention group and primary control group selected randomly from members of a prescription benefit plan. An intervention consisting of a brochure and a wallet card was mailed to respondents in the intervention group who had responded to the pre-intervention survey. A post-intervention survey was mailed to individuals in the intervention group and the primary control group who responded to the pre-intervention survey and individuals in a secondary control group that had not been previously surveyed. The patient medication risk reduction scale was analyzed using exploratory factor analysis with promax rotation. Internal consistency of the scale and its subscales was determined using Cronbach\u27s alpha and item-total correlations. Changes in overall mean scale scores from pre-intervention to post-intervention were compared between the intervention group and the primary control group to determine the effect of intervention. Relationships between demographic variables and overall scale scores were assessed with one-way analysis of variance. Factor analysis reduced the preliminary 22 medication behavior items to a final scale of 18 items with four subscales: “asking,” “telling,” “writing” and “ensuring understanding”. The reliability of the scale measured by Cronbach\u27s alpha was 0.89. Patients performed behaviors related to writing medication-related information less frequently than behaviors related to understanding medication-related information. The frequency of medication risk reduction behaviors increased with increase in age of respondents. The relationship remained after controlling for all other demographic variables. Exposure of respondents to survey significantly increased medication risk reduction behaviors. However, the informational brochure did not have any significant additional impact on medication risk reduction behaviors

Treatment evolution after COPD diagnosis in the UK primary care setting.

To assess the treatment progression during the 24 months following a formal diagnosis of chronic obstructive pulmonary disease (COPD) in the UK primary care setting.A retrospective cohort of newly diagnosed COPD patients was identified in the Clinical Practice Research Datalink (CPRD) from 1/1/2008 until 31/12/2009. Maintenance therapy prescribed within the first 3 months of diagnosis and in the subsequent 3-month intervals for 24 months were analyzed. Treatment classes included long-acting β2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), inhaled corticosteroids (ICSs), and respective combinations. At each 3-month interval, discontinuation, switching, addition, and stepping down patterns were analyzed cumulatively for the first 12 months and over the 24-month of follow-up.A total of 3199 patients with at least one prescription of a maintenance therapy at baseline and during 4th-6th month interval were included in the analysis. At diagnosis (0-3 months), the most frequently prescribed maintenance therapy was LABA+ICS (43%), followed by LAMA (24%) and LABA+LAMA+ICS (23%). Nearly half the patients (LABA-50%, LAMA-43%) starting on a monobronchodilator had additions to their treatment in 24 months. Compared to other medications, patients starting on a LAMA were most likely to escalate to triple therapy in 24 months. Nearly one-fourth of the patients prescribed triple therapy at baseline stepped down to LABA+ICS (25%) or LAMA (31%) within 24 months.Disease progression is evident over the 24 months after COPD diagnosis, as more patients were prescribed additional maintenance therapy in the 24-month period compared to baseline. The changes in therapy suggest that it is difficult to achieve a consistently improved COPD disease state

Cost-effectiveness of scheduled maintenance treatment with infliximab for pediatric Crohn's disease.

BACKGROUND: Infliximab recently became the only biologic approved for use in pediatric patients with severe active Crohn's disease (CD). OBJECTIVES: To estimate the cost-effectiveness of scheduled maintenance treatment with infliximab compared with standard care in children suffering from severe active CD over 5 years from the UK National Health Service perspective. METHODS: A Markov model was constructed to simulate the progression of a hypothetical cohort of CD children through predefined health states on scheduled maintenance treatment with infliximab (5 mg/kg). The data to populate the model came from infliximab trials from Targan et al., ACCENT I, and REACH. The health states included in the model were remission, responding active disease, nonresponding active disease, surgery, postsurgery remission, postsurgery complications, and death. Standard care, comprising immunomodulators, and/or corticosteroids were used as a comparator. The primary outcome was quality-adjusted life-years (QALY) estimated using the EuroQol (EQ-5D) from a European CD population. To account for the weight-based dosing of infliximab, a baseline patient weight of 40 kg that increased by 5 kg/year up to 60 kg was used. The costs and outcomes were discounted at 3.5% over a period of 5 years. Probabilistic sensitivity analyses were performed by varying the infliximab efficacy estimates, costs, and utilities. RESULTS: The incremental cost-effectiveness ratio (ICER) for infliximab treatment was pound14,607 compared with standard care. The sensitivity analyses revealed the treatment effect of infliximab to be the most influential parameter with ICERs ranging from pound10,480 to pound37,017. Assuming a willingness to pay of pound30,000 per QALY, the probability of infliximab being cost-effective is 78.6%. CONCLUSION: Scheduled maintenance treatment with infliximab (5 mg/kg) is likely to be a cost-effective treatment in children suffering from severe active CD under an 8-week maintenance program

Maintenance prescriptions at diagnosis.

<p>Patients (n = 3199) prescribed maintenance therapy at baseline and 3–6 months excluding patients with no treatment, SABD alone, ICS, and others. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist.</p