Work

The pharmacoepidemiology of COPD: Recent advances and methodological discussion

Year: 2003

Type: article

Abstract: Mortality rates from chronic obstructive pulmonary disease (COPD) vary across Europe.However, the continuing elevated prevalence rates of current smoking among males and the increasing trend observed in females in the last decades predicts an increase of COPD mortality in many countries in the coming years.The real prevalence of COPD within a given population may vary widely depending upon the tools used for its identification: reported respiratory symptoms, medical diagnosis and abnormal lung function.Even when the diagnosis is based on an objective tool like spirometry, largely variable prevalence rates are found within the same population.In view of the different criteria endorsed by different scientific societies, it is clear that further research is needed to reach a standardised criterion for airways obstruction.Patients underestimate their own morbidity and may therefore be undertreated.The cost of COPD, largely driven by exacerbations, is expected to increase considerably in the future, reflecting the previous smoking habits of an ageing population.The impressive prevalence in current smokers v45 yrs of age in most countries highlights the need to improve the quality of prevention; early detection and screening programmes may be useful in this population of smokers.The burden of illness and economic evaluation for COPD S.D. Sullivan SummaryThis article reviews the important factors to consider in the design of economic evaluations or cost-effectiveness analyses (CEAs) of chronic obstructive pulmonary disease (COPD) treatments.The relevant costs associated with COPD can be divided into direct (direct medical and direct nonmedical) and indirect (programme and productivity) costs.The differences between the human-capital and friction-cost approaches to evaluate the impact of productivity loss are discussed.Since the primary cost-driver for COPD is hospital care for exacerbations, this may be the major outcome measure of interest in COPD economic evaluation studies.Robust CEA evaluations that take into account all of these factors will aid decisionmakers in evaluating COPD therapies.Possible sources of bias in observational studies of the effectiveness of inhaled corticosteroids in COPD S. Suissa

Source: European Respiratory Journal

DOI: 10.1183/09031936.03.00060003