Micro Economic Analysis Of The COPD Exacerbations And Hospitalizations Burden On The Health Care System In Bulgaria

OBJECTIVES: COPD is a leading cause for morbidity and mortality worldwide. Exacerbations have a major impact on severity of the disease, the hospitalizations' rate and their costs. The objective of this study is to analyse the cost of COPD exacerbations and related hospitalization rate in Bulgaria before and after the introduction of new inhaler devices. METHODS: It is an ambispective observational study of real life therapy on a representative cohort of 426 COPD patients. Data for exacerbations, hospitalization rate and their cost was collected according to the severity of the disease. Patients were divided in three subgroups depending on the prescribed therapy. As "new" therapy was considered all INNs introduced on the national market after 2013, INNs before 2013 were coded as "old" therapy and the combination of both was considered as combined therapy. Micro-costing approach was applied to evaluate the total and mean medical costs on exacerbations therapy and exacerbation-related hospitalizations. Descriptive statistics and Kruskal-Wallis test were applied. RESULTS: Patients assigned to new therapy (12%) with new inhaler devices experienced fewer exacerbations with hospitalizations than the patients treated with the medicines available in the Bulgarian market before 2013 (p=0.000029 for exacerbations without and p=0.00420 for exacerbations with hospitalization). The total cost of exacerbations varied from 59 to 309 euro (without hospitalization) and from 3968 to 58840 euro (with hospitalization) depending on the type of therapy. The average cost of exacerbation with hospitalization increased with the progression of the disease and was the lowest for the patients receiving new therapy. CONCLUSIONS: The results suggest that the new therapy with improved inhaled devices might be more effective as a management therapy than the old or combination therapies and could reduce the exacerbation-related cost.