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Patients With COPD Who Work Have Greater Productivity Losses

Allison Inserro
Patients with chronic obstructive pulmonary disease who work are costly to their employers in both direct and indirect costs and have greater productivity losses, according to a recent study.
Patients with chronic obstructive pulmonary disease (COPD) who work are costly to their employers in both direct and indirect costs and have greater productivity losses, according to a recent study.

Using commercial insurance data between 2007 and 2010, the study looked at a nationally representative sample of working age patients aged 18 to 65 with COPD with employer-sponsored insurance.

In the United States, direct healthcare expenditures for COPD account for more than half of the national projected economic cost for this disease ($30 billion of $49.9 billion, according to a 2010 estimate). Indirect costs from illness, primarily associated with lost productivity, are responsible for $8 billion of the projected total cost. Indirect mortality costs account for $14.8 billion.

By 2020, COPD, which is largely preventable and often stems from smoking, is expected to be the third-leading cause of death.

In this study, patients were included if they had at least 1 hospitalization or 1 emergency department visit or 2 outpatient visits. The average age of the participant was 53 and most were male (67.5%).

Direct cost estimates were computed using paid amounts on all medical and pharmacy claims, regardless of diagnosis. Indirect costs were estimated from the costs paid for short-term disability claims.

Patients with very severe disease (classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria) incurred up to 6 times the cost of a non-COPD control group, the authors noted.

Of the 5701 patients with COPD, 3.6% patients were frequent exacerbators (≤2 times), 10.4% patients were infrequent exacerbators (1 time), and 86% patients were nonexacerbators (0 times). When compared with the 17,103 patients without COPD, the incremental direct cost of COPD was estimated at $6246 per patient per year (95% CI: $4620, $8623; P < .001).

Loss in productivity was significantly greater in patients with COPD, with an average of 5 more days per year of absence from work and incremental indirect costs from short-term disability of $641 (< .001).

Direct costs for frequent exacerbators ($17,651 per year) and infrequent exacerbators ($14,501 per year) were significantly higher than those for non-exacerbators ($11,395, < .001).

This study reveals a number of statistically significant predictors of high incremental costs associated with COPD, and found that productivity claims associated with COPD were responsible for 10% of the overall cost burden. Direct costs for patients with frequent exacerbations were 22% higher than for patients with infrequent exacerbations and 55% higher than for those classified as non-exacerbators.

The authors said the estimate of indirect costs may actually be underestimated, as the only proxy used was short-term disability. It did not include absenteeism, presenteeism, or long-term disability.


Patel JG, Coutinho AD, Lunacsek OE, Dalal AA. [published onlione July 30, 2018]. COPD affects worker productivity and health care costs. Int J Chron Obstruct Pulmon Dis.  doi: 10.2147/COPD.S163795.

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