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    Projecting Long-Term Health and Economic Burden of COPD in the United States

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    Author
    Zafari, Zafar
    Li, Shukai
    Eakin, Michelle N
    Bellanger, Martine
    Reed, Robert M
    Date
    2020-10-02
    Journal
    Chest
    Publisher
    Elsevier Inc.
    Type
    Article
    
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    See at
    https://doi.org/10.1016/j.chest.2020.09.255
    Abstract
    Background: In the United States, COPD is a leading cause of mortality, with a substantial societal health and economic burden. With anticipated population growth, it is important for various stakeholders to have an estimate for the projected burden of disease. Research Question: The goal of this study was to model the 20-year health and economic burden of COPD, from 2019 to 2038, in the United States. Study Design and Methods: Using country-specific data from published literature and publicly available datasets, a dynamic open cohort Markov model was developed in a probabilistic Monte Carlo simulation. Population growth was modeled across different subgroups of age, sex, and smoking. The COPD prevalence rates were calibrated for different subgroups, and distributions of severity grades were modeled based on smoking status. Direct costs, indirect absenteeism costs, losses of quality-adjusted life years (QALYs), and number of exacerbations and deaths associated with COPD were projected. Results: The 20-year discounted direct medical costs attributable to COPD were estimated to be $800.90 billion (95% credible interval [CrI], 565.29 billion-1,081.29 billion), with an expected $337.13 billion in male subjects and $463.77 billion in female subjects. The 20-year discounted indirect absenteeism costs were projected to be $101.30 billion (70.82 billion-137.41 billion). The 20-year losses of QALYs, number of exacerbations, and number of deaths associated with COPD were 45.38 million (8.63 million-112.07 million), 315.08 million (228.59 million-425.33 million), and 9.42 million (8.93 million-9.93 million), respectively. The proportion of disease burden attributable to continued smoking was 34% in direct medical costs, 35% in indirect absenteeism costs, and 37% in losses of QALYs over 20 years. Interpretation: This study projects the substantial burden of COPD that the American society is expected to incur with current patterns for treatments and smoking rates. Mitigating such burden requires targeted budget appropriations and cost-effective interventions.
    Rights/Terms
    Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
    Keyword
    COPD
    Monte Carlo simulation
    economic burden projection
    health burden projection
    stochastic dynamic Markov model
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/15113
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.chest.2020.09.255
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