Comment
COPD generates substantial cost for health systems
Chronic obstructive pulmonary disease (COPD) is a consider when planning interventions to reduce the See Articles page e1183
substantial public health concern worldwide. The economic burden of COPD. In low-income and middle-
economic cost of COPD includes the expenses incurred income countries (LMICs) such as India, the private
for COPD screening, diagnosis, and management, health sector also plays a central role in the health
the direct and indirect costs of which add a burden to economy, and its involvement as a key stakeholder
health systems, directly impacting countries’ health needs to be considered. Research with integrated
budgets. The economic cost of COPD in the USA is approaches is warranted, involving all relevant
substantial and is increasing—COPD had a projected stakeholders to combat the increasing burden of
cost of US$49 billion in 2020.1 The estimated direct COPD. Most data on the cost of COPD have come from
cost of COPD in Europe was reported to range from studies in the USA and Europe, with little work being
€1963 to €10 701 per patient per year.2 In India, COPD done in Asian countries despite Asia having a higher
incurs 2–4-fold higher costs compared with asthma COPD burden.7
and ischaemic heart disease3 and studies have shown To fully understand the implications of the burden
that the costs of managing acute exacerbations of of COPD, it needs to be described in terms of societal
COPD contribute 45–70% to the total expenses of COPD and individual or household financial consequences.8
management. COPD causes an economic loss of more There is a considerable out-of-pocket health-care
than 100 000 crore rupees (US$13·4 billion) per annum cost for patients with COPD, particularly among those
in India,4 which is forecast to increase in the coming with severe COPD because they have exacerbations
years due to the increased prevalence of COPD and poor and frequent hospitalisations. Patients with COPD
awareness of COPD among the community and health- need support in dealing with their disease, as many
care professionals.5 face emotional as well as physical challenges. Further
In The Lancet Global Health, Simiao Chen and research is needed to better understand the emotional
colleagues6 provide a comprehensive picture of the challenges faced by people with COPD.
economic burden of COPD in countries and territories Increasing awareness of COPD is essential to educate
globally, which will help organisations such as WHO, society. Researchers and policy makers could plan some
the European Respiratory Society, and the American cost-effective interventions highlighting the need to
Thoracic Society to design policy at the country adopt different cost-related policy approaches according
level (if needed). Chen and colleagues’ findings to the course of the disease burden. Community-based
could help individual countries to plan strategies to screening with the help of community health workers
reduce the burden of COPD and inform updates of could make a real difference in reducing economic
the COPD screening, diagnosis, and management loss from COPD if individuals are diagnosed at an early
guidelines, led by the Global Initiative for Chronic disease stage. Awareness among the community
Obstructive Lung Disease. Chen and colleagues’ study and involvement of all stakeholders are also crucial.
contributes substantially to the current literature, and Research is needed to study current challenges with
researchers could use the findings to develop future use of spirometry in the field for confirming diagnosis,
implementation research in countries with a high so that simplified spirometry might be developed as
burden of COPD, helping to design solutions to reduce an alternative. Screening and diagnosing COPD at an
the economic burden of COPD. The local context for early stage can help save substantial direct and indirect
screening, diagnosis, and management of COPD differs costs for both patients and the public health system.
from country to country due to variations in health Interventions using innovative and locally made
system infrastructure and services provided. Within technology will allow every patient, even in rural and
a country such as India, there are a lot of variations remote areas, to be diagnosed early in their disease
at the state level when it comes to health system course and attain a better health-related quality of life
infrastructure, services, and policies. These are crucial with regular interventions provided by the existing
factors that researchers and policy makers need to primary health system.
www.thelancet.com/lancetgh Vol 11 August 2023 e1138
Comment
I declare no competing interests. 3 Lamprecht B, Soriano JB, Studnicka M, et al. Determinants of underdiagnosis
of COPD in national and international surveys. Chest 2015; 148: 971–85.
Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open
4 Madas S, Londhe J, Mudliar K, et al. What are the direct and indirect costs of
Access article under the CC BY 4.0 license.
COPD in India? Eur Respir J 2022; 60 (suppl 66): 3373.
5 Miravitlles M, Ribera A. Understanding the impact of symptoms on the
Dhiraj Agarwal burden of COPD. Respir Res 2017; 18: 67.
[email protected] 6 Chen S, Kuhn M, Prettner K, et al. The global economic burden of chronic
Vadu Rural Health Program, KEM Hospital Research Centre, Rasta Peth, obstructive pulmonary disease for 204 countries and territories in
Pune 411011, Maharashtra, India 2020–50: a health-augmented macroeconomic modelling study.
Lancet Glob Health 2023; 11: e1183–93.
1 Larsen DL, Gandhi H, Pollack M, Feigler N, Patel S, Wise RA. The quality of 7 Rehman AU, Hassali MAA, Muhammad SA, et la. The economic burden of
care and economic burden of COPD in the United States: considerations for chronic obstructive pulmonary disease (COPD) in the USA, Europe, and
managing patients and improving outcomes. Am Health Drug Benefits Asia: results from a systematic review of the literature.
2022; 15: 57–64. Expert Rev Pharmacoecon Outcomes Res 2020; 20: 661–72.
2 Rehman AU, Hassali MAA, Muhammad SA, Harun SN, Shah S, Abbas S. 8 Nielsen R, Johannessen A, Benediktsdottir B, et al. Present and future costs
The economic burden of chronic obstructive pulmonary disease (COPD) in of COPD in Iceland and Norway: results from the BOLD study. Eur Respir J
Europe: results from a systematic review of the literature. Eur J Health Econ 2009; 34: 850–57.
2020; 21: 181–94.
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