Cost of COPD

The cost of COPD in Europe

COPD is costly for patients, the healthcare system and society as a whole (Figure 5) [1]. Due to its high prevalence and mortality rate, COPD’s direct cost accounts for 6% of total healthcare spending in the European Union (equivalent to €38.6 billion per year) and 56% of the total cost of treating respiratory diseases [2]. It is estimated that, between 2020 and 2050, COPD will cost the world economy INT$4·3 trillion. A thorough understanding of the economic implications of COPD is a prerequisite for sound, evidence-based policy making [1]. Furthermore, costs related to medications and hospitalisations are only a fraction of the burden of COPD. The real costs of COPD remain underreported and may be underrepresented due to underdiagnosis.

Figure 5. Macroeconomic burden of COPD in 2020-50

20-40
40-60
60-80
80-100
100-120
120-140
140-160
160-180
180-200

Proportion of total gross domestic product (GDP) in 2020–50, × 10−3% (results are expressed as 0.001% of the GDP within a country’s borders over the specified period (2020–50).

Modified from Chen 2023.

“A lot of money goes into medication and there’s tiredness. ”

COPD patient, Finland

“I would like government to improve quality of life living with COPD – to make work less stressful and building awareness in the employer.”

COPD patient, Poland

Direct costs: More severe COPD result in higher costs

The estimated direct cost of COPD in Europe ranges from €1,963 to €10,701 per patient per year [3] [4]. Exacerbations account for the largest direct costs for COPD treatment. The highest costs associated to exacerbations are due to hospitalisations, followed by medication, including oxygen therapy. Hospitalisation costs range from €1,316 for mild COPD to €8,472 for severe COPD [3]. The mean cost of hospital admission for COPD exacerbation ranged from € 331 in the UK to € 6,291 in Norway and the average cost of hospitalisation per patient in euro ranged from € 840 to € 1799 (Figure 6). Overall, the hospital admissions costs due to COPD exacerbations- accounted for 13% of all hospital admissions in 2015 [3]. Although the severity of COPD does not significantly affect hospital stay duration, it does increase hospitalisation costs, particularly in very severe cases that require admission to intensive care units. In Spain, taking into account the severity of COPD, patients with severe COPD generated an expense of €3,335 per year (85% of which corresponds to hospital expenses for admissions due to exacerbations), those with moderate COPD €2,275 per year, and patients with mild COPD €1,650 per year [5]. Costs related to prescriptions ranged from €772 in Sweden to €2,640 in Germany to [3]. Medications are also a significant portion of COPD costs, accounting for approximately 25% of direct costs, and they are influenced by disease severity. In fact, they increase from €389 per year for mild COPD to €5,154 for severe COPD [3]. The cost of medications during exacerbations varies based on their frequency, with added expenses for antibiotics and supplemental oxygen. Strategies aimed at reducing exacerbation frequency can lead to savings on medication expenses and overall healthcare costs.

Direct costs are also higher in patients with comorbidities, in particular among those living with arthritis and myocardial infarction [6]. Overall, hospitalisation and drug costs are the main costs associated with exacerbations [3].

Improvements in healthcare services and specialised COPD management programmes have proven to be able to decrease hospitalisation rates among COPD patients. A critical point in the management of COPD is access to follow-up visits after exacerbations to closely monitor the patients’ conditions. In the survey conducted by EFA in 2023, patient organisations from Austria, France, and Italy rated the access to follow-up visits after hospitalisation as “very poor/poor”; responders from the Netherlands, Spain, Sweden, and Turkey considered it “average”, while only Iceland, Ireland, and Portugal rated it as “good” or “very good”. A survey conducted among patients by the Swedish Heart and Lung Association found that 54% of respondents were not called for follow-up after exacerbation or did not recall it [7].

Figure 6. Average cost of hospitalisation per patient in euro

Modified from Rehman et al. 2020.

Indirect costs of COPD: A significant loss of human capital and productivity

Indirect COPD costs often outweigh direct costs, thereby placing a significant burden on COPD patients and society as a whole. The ratio of indirect costs over direct costs is 61% in Italy, 82% in the Netherlands, and 83% in the UK [8]. The highest indirect costs are due to loss of productivity and early retirement. Seventy percent of patients with COPD report limitations in physical activity, and 51% report reduced work productivity [9] . Patients may take more sick days off work than healthy peers. They may need reduced working hours or may face early retirement due to their condition. Thus, COPD can significantly impact patients during productive years. Decreased productivity can also lead to stress and strain on both the affected individual and their employers.

Loss of productivity and income increases the economic burden not only for affected individuals, but also for society as a whole. Within the countries surveyed in this research, Germany reports the highest annual cost per patient due to work productivity loss (€5,735,) and Italy the lowest (€397). Early retirement expenses account for 40-82% of the overall indirect COPD management costs. Germany had the highest cost for early retirement (€19,031) and Sweden the lowest (€3,695) [10]. The prevalence of COPD in patients older than 55 years of age ranges from 9.7% in Poland to 21.4% in the UK [11]. It is therefore conceivable that the loss of productivity and early retirement represent a significant loss of human capital.

COPD also affects the mental wellbeing of the patients, their family, and friends. Considering the increased ageing of the European population, prevention and management of COPD should be considered a top priority in reducing both the direct and indirect costs of COPD and alleviating the pressure on the healthcare systems. Encouraging preventive measures, such as smoking cessation and occupational safety practices, can help reduce the incidence of COPD and its impact on the workforce and productivity. Furthermore, early detection and early treatment can reduce the progression of the disease and prevent disability. A study of 426 Bulgarian COPD patients calculated that, on average, patients with mild COPD spend 0.62 years in disability, while those with moderate and severe disease spend 6 and 9 years, respectively. The corresponding indirect cost per patient were €3,596; €34,204 and €51,332 [12].

Overall, addressing the burden of COPD during productive years requires a holistic approach that includes management strategies, workplace accommodations, mental health support, and public health initiatives aimed at prevention and early intervention. By focussing on these aspects, it is possible to mitigate the impact of COPD on individuals’ productivity and enhance their overall wellbeing.

Measures to promote active living that may keep the patients active and improve their quality of life can also reduce societal costs of COPD.

Hidden costs of COPD: The burden of home-based care and out-of-pocket costs

The hidden costs of COPD encompass a variety of expenses, such as transportation, comorbidities (like osteoporosis, glaucoma, diabetes, and cardiovascular diseases), and home care. Indeed, the true cost of home-based care is much higher than the estimated direct medical expenditure because the latter does not consider the economic value of the non-medical care provided by formal and informal caregivers (which are often family members) [13]. Notably, the recognition of informal caregivers is not consistent across European countries and may depend on local healthcare authorities, social services, or caregiver support organisations. Only recently, in Ireland, informal caregivers have received recognition and may access benefits such as the right to days off work and financial assistance or compensation for taking care of the patient (see “The burden of COPD on informal caregivers”).

Other hidden costs include non-medical expenses like expenses for transportation and meals, as well as intangible costs like disability and the need for psychological support. In addition, adapting a home to make it accessible represents a hidden medical cost. All these costs can impact the patients, their families, and society as a whole. Furthermore, exacerbations and frequent hospitalisations also carry considerable hidden costs for patients with COPD, particularly among those with severe COPD [4]. Patients often have to pay for their prescribed medicines (up to 65% of patients report making full or partial payments), antibiotics (60%), medical aids (59%), and transportation (53%) [14]. Typically, patients incur out-of-pocket co-payments for these expenses. In the Netherlands, patients with COPD are entitled to reimbursement for “hidden costs”, including costs for transportation, higher energy costs due to the use of oxygen, etc. Nevertheless, there is no common care strategy and plan for patients with COPD in Europe.

Overall, when considering the cumulative expenses, including those associated with comorbidities, the financial burden of COPD can become challenging, particularly for individuals with modest financial means. Financial pressure on patients and their families might indirectly impact patients’ care, particularly in patients with chronic diseases and multimorbidity. Patients may even have to restrict their access to medical consultations or treatments due to financial restrictions [15].

Me and COPD (Finnish)

In the 3-part series both patients and doctors share their perspectives, addressing everyday questions about the disease that can evoke strong emotions.

Box 5

Direct and indirect costs

Direct costs relate to hospital care (including emergency room stays and consultations with specialists), primary care visits and treatment (e.g., drugs and oxygen therapy).

Indirect costs, namely decreasing productivity caused by work absences and sick-leave, early retirement, and use of nursing services.

Conclusion: The costs of COPD

The economic and social burden of COPD has not decreased since 2013, while costs have increased and are expected to further increase in the future, in particular due to the ageing of the European population. The high management costs of COPD are due to delayed diagnosis, disease severity, frequency of exacerbations, emergency room, hospitalisation, increased risk of exacerbations, poor adherence to therapy, and exposure to COPD risk factors [3]. Holistic multidisciplinary COPD management programmes that improve coordination among hospitals, specialists, and community services are a cost-effective approach to the management of COPD. Similar management programmes have been successfully implemented for other chronic diseases like asthma, diabetes, and chronic heart failure [16].

The indirect costs of COPD due to loss of productivity and early retirement must also be addressed. Loss of productivity must be considered not only from an economic perspective. Patients with COPD often face emotional and physical challenges that need to be better understood [4]. Such challenges increase the burden on patients who do not have access to multidisciplinary support and tend to slow down and reduce social activities, with implications for their families and carers. Promoting mental wellbeing and active living should be considered a priority for patients with COPD, who might also need specific economic support measures to cope better with the disease.

Recommendations

Strengthening National and European Approaches to COPD Care

Establishing lung health plans is essential to anchor COPD management within primary care settings, thereby reducing costs for both healthcare systems and patients.

At national level:

Break down silos for COPD multidisciplinary care: Multidisciplinary COPD care in the primary care level improves the early detection of COPD, slows down the disease progression, enables better management of comorbidities, thereby reducing associated direct costs.
Design strategies to reduce COPD indirect costs: Develop national strategies to tackle the indirect costs of COPD, such as sick leave, early retirement, and reduced productivity.
Pilot cost-effective prescription and reimbursement schemes: Introduce pilot schemes for the prescription and reimbursement of early COPD interventions and scale up their cost-effectiveness.
Optimise the distribution of healthcare force to meet the needs of COPD patients: Improve the organisation of healthcare workers to support COPD care by equipping primary care services with trained respiratory (community) nurses, and lung function testing devices to improve early detection.

At European level:

Prioritise lung health and COPD in EU financial instruments: Prioritise action on lung health and specifically on COPD through the EU4Health and Horizon programmes genuinely addressing chronic diseases.
Develop policies that support inclusion of COPD patients in the workforce: Develop and promote supportive policies that keep and integrate COPD patients in the workforce to promote active living, thereby reducing preventable absenteeism and indirect costs associated with the disease.
Develop comprehensive lung health training programmes for healthcare professionals: Earmark training programmes under the European Social Fund (ESF) aimed at incentivising healthcare professionals (including primary care providers, nurses, and physiotherapists) and medical specialists involved in chronic respiratory diseases to promote early diagnosis and optimal management of care for COPD.
Strengthen “Health at Work” Policies: Integrate lung health into policies addressing occupational exposure to chemicals, in order to prevent respiratory diseases and to reduce healthcare costs associated to decreased lung function due to occupational exposure.
Enhance technical support for COPD care through WHO/Europe: Guide WHO Europe Member States with roadmaps, technical support, and success indicators to strengthen healthcare systems’ capacity to monitor and deliver COPD care.

References

1. Chen S, Kuhn M, Prettner K, Yu F, Yang T, Bärnighausen T, et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modelling study. Lancet Glob Health. 2023;11:e1183–93.↩

2. Forum of International Respiratory Societies. The global impact of respiratory disease. Third Edition. 2021.↩

3. Rehman AU, Hassali MAA, Muhammad SA, Harun SN, Shah S, Abbas S. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. Eur J Health Econ. 2020;21:181–94.↩

4. Agarwal D. COPD generates substantial cost for health systems. Lancet Glob Health. 2023;11:e1138–9.↩

5. Consejería de Sanidad. Plan Estratégico en EPOC de la Comunidad de Madrid. 2013.↩

6. Kirsch F, Schramm A, Schwarzkopf L, Lutter JI, Szentes B, Huber M, et al. Direct and indirect costs of COPD progression and its comorbidities in a structured disease management program: results from the LQ-DMP study. Respir Res. 2019;20:215.↩

7. Riksförbundet HjärtLung. [COPD survey 2023]. 2023.↩

8. Souliotis K, Kousoulakou H, Hillas G, Tzanakis N, Toumbis M, Vassilakopoulos T. The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece. Int J Chron Obstruct Pulmon Dis. 2017;12:1395–400.↩

9. Guarascio AJ, Ray SM, Finch CK, Self TH. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res. 2013;5:235–45.↩

10. Gutiérrez Villegas C, Paz-Zulueta M, Herrero-Montes M, Parás-Bravo P, Madrazo Pérez M. Cost analysis of chronic obstructive pulmonary disease (COPD): a systematic review. Health Economics Review. 2021;11:31.↩

11. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. 2020.↩

12. Tachkov K, Kamusheva M, Pencheva V, Mitov K. Evaluation of the economic and social burden of chronic obstructive pulmonary disease (COPD). Biotechnology & Biotechnological Equipment. 2017;31:855–61.↩

13. GOLD. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report). 2024.↩

14. EFA. EFA 2019 Active Patients Access Care. Brussels, Belgium: European Federation of Allergy and Airways Diseases Patients’ Associations; 2019.↩

15. Larkin J, Foley L, Smith SM, Harrington P, Clyne B. The experience of financial burden for people with multimorbidity: A systematic review of qualitative research. Health Expect. 2021;24:282–95.↩

16. OECD. Realising the Potential of Primary Health Care. 2020.↩

Previous chapter

Burden of COPD

Next chapter

Disease and awareness

Cost of COPD

Cost of COPD

The cost of COPD in Europe

Direct costs: More severe COPD result in higher costs

Indirect costs of COPD: A significant loss of human capital and productivity

Hidden costs of COPD: The burden of home-based care and out-of-pocket costs

Me and COPD (Finnish)

Box 5

Direct and indirect costs

Conclusion: The costs of COPD

Recommendations

Strengthening National and European Approaches to COPD Care

At national level:

At European level:

References

About

What is copd

Burden of copd

Cost of COPD

Disease awareness

COPD Prevention

COPD Early Diagnosis

COPD Care Acces

Quality of Life with COPD

Digital Health for COPD

The Impact of COVID-19 on COPD Care

Recommendations