Economic Impact of Leading Prosperity Diseases: COPD in South East Europe

Abstract

ECONOMIC BURDEN OF COPD Chronic obstructive pulmonary disease is one of the leading “prosperity diseases” worldwide. Pooled global prevalence rates based on clinical assessments and spirometry ranged from 7.6 to 8.9%, reported in a sound meta-analytical study design (1). It has far reaching consequences, not only for an affected patient’s health but also for the entire national health systems (2). These refer to the substantial work load for the medical facilities due to chronic clinical course of illness and modest success of available treatment approaches. COPD attributable resource utilization patterns are particularly substantial if large university tertiary care hospitals, specialist clinics, and intensive care units are observed (3). According to most of published evidence the key cost driver are periodic exacerbations followed by intensive care unit admissions and episodes of infectious complications (4). Among major cost domains, physician consultations and surgery dominate in high-income settings. Unlike in the West, within the most of South Eastern European region, COPD medical care is still dominated with acquisition costs of pharmaceuticals and oxygen (5) and imaging diagnostics (6). Outpacing of indirect productivity-related opportunity costs by the direct costs of inand outpatient medical care is common to this region due to substantially lower wages of physicians and nursing staff (7). Apart from direct costs of COPD, mainly constituted from the resources consumed in the health care process, including costs of ambulatory care, drug treatment, hospital care, rehabilitation, and long-term home care, there are substantial indirect costs of COPD, which are incurred by productivity losses, premature retirement, and premature mortality from this disease. The indirect costs for premature mortality are being calculated through human capital approach, with the life years lost up to the age of 65 multiplied by the gross annual income. An insight into the economic reality of SEE region, particularly Serbia, with average wages significantly lower than in countries of the Western Europe, but at the same time with high unemployment rates in younger age groups, where some 50% of the working population is currently outside of the workforce (8), being in their most productive decades of life but at the same time most prevalent tobacco users, makes indirect cost of COPD in SEE region very difficult to calculate or even predict, but clearly shows significant magnitude of this burden in present years, and probable rise of these costs in the future. Intangible costs are not convertible into monetary terms and units, they are specifically related to the distress and suffering, which is caused by the disease. General lack of insight into patients’ perception of the disease and limitation and incapability, which it imposes, while healthcare workers are being focused mainly on physical burden of the disease, with very few patients being provided with structurised psychosocial aid in the attempt to overcome significant yet underestimated mental and emotional burden of the disease, makes these costs impossible to predict and foresee.