Chronic obstructive pulmonary disea...

Chronic obstructive pulmonary disease (COPD) is single of the most common diseases in the United States, and it has a significant medical and financial impact upon the health care system. instant projections show that COPD-related morbidity and mortality will increase rapidly across the next 20 years. The inferences of multiple studies show that inhaled corticosteroids have a positive influence forward airway responsiveness, reduce exacerbations, and gradual the normal decline in health status for patients with COPD Sin and associates evaluated the splendor effectiveness of inhaled corticosteroids in patients with COPD to determine which patient clusters should receive this class of medication.

The inquiry design was a cost analysis using an established standard that reviewed the effectiveness of four strategies for the use of inhaled corticosteroids in the treatment of COPD These four strategies included: (1) no use in all stages of disease, (2) use in all stages, (3) use in patients with stage 2 or 3 disease, and (4) use single in those with stage 3 disease. Stage 2 disease is defined as a forced expiratory mass in one second (FEV1) of 35 to 50 percent of predicted, while stage 3 is an FEV1 of les than 35 percent of predicted. The authors used pub-lished data to estimate mortality, exacerba-tions, and disease progression rates using the four strategies and examined the price associated with care of COPD patients and quality-adjusted life-years (QALYs). They used a time gauge that evaluated this feature through a three-year time period.

The sample of patients used in the pattern had a mean age of 61; 21 percent were women 87 percent were white, 97 percent were generally received or former smokers, 40 per-cent were generally received smokers, and there was a total of 54 pack-years of smoking. The total marginal charge over three years of inhaled corticosteroids if given alone to patients in stage 2 or 3 of the disease would be $922 by person. If inhaled corticosteroids were given to all patients with COPD the sumptuousness would be $3,612 per bodily substance If corticosteroids were given and nothing else to those with stage 3 disease, the total marginal outlay would be $774.

If corticosteroids were given solitary to those with stage 2 or 3 disease, the take away from was $17,000 per QALY gained. If this treatment was reserv for those in stage 3 disease, the take away from was $11,100 per QALY gained. If inhaled corticosteroids were given to all patients with COPD regardless of disease severity, the take away from was $46,200 per QALY gained. Using a benchmark of $50000 by QALY gained, there would be a 57 percent probability that the strategy to provide this therapy to all patients with COPD would be effective. Using the same benchmark, the probability increased to 95 percent in patients with stage 2 or 3 disease and to 84 percent in those with stage 3 disease.

The authors terminate that using inhaled corticosteroids in patients with COPD patients at stages 2 and 3 is charge effective, and the cost is similar to that of other public treatments. They add that patients with increased disease severity may benefit from this treatment strategy.

Sin DD et al. Cost-effectiveness of inhaled corticosteroids for chronic obstructive pulmonary disease according to disease severity. Am J M March 1 2004;116:325-31

COPYRIGHT 2005 American Academy of Family Physicians

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