Copd Uncovered: Health Care Resource Use and Cost of Chronic Obstructive Pulmonary Disease in Japan

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Connolly M1, Kotsopoulos N2, Chen S3, Hwang S4 1University of Groningen, Groningen, The Netherlands, 2Health Policy Institute, Athens, Greece, 3Pfizer Inc, Hong Kong, Hong Kong, 4Pfizer Korea, Seoul, South Korea

Objectives: Conventional economic analyses of smoking cessation may exclude important economic gains. From the governments’ perspective, smoking represents a source of tax revenue and a public health cost. Apart from smoking-attributable mortality and morbidity, there is an established relationship between smoking and reduced productivity. In this research we assess how public investments in smoking cessation that changes productive output can influence future government tax revenue and social transfer costs.  Methods: The analysis described here follows the generational accounting framework developed to assess intergenerational relationships between morbidity and mortality and lifetime tax revenue and social transfers for government. Based on the current prevalence of smoking in Korea, a cohort model was developed for smoker, former-smokers and non-smokers. The model simulated the lifetime discounted fiscal transfers for each of the aforementioned segments in Korean Won (KRW) based on 2012 costs.  Results: In addition to the health costs, smoking results in foregone earnings and tax due to premature mortality and decreased productive output of smokers. The average per person health cost savings from smoking cessation were estimated at KRW974,000. Smoking cessation resulted in average lifetime tax revenue gain of KRW 4,214,120 and KRW 1,442,050 per person for the age groups of 24-45 and 45-65, respectively. The corresponding average tax revenue loss due to lower tobacco consumption were KRW2,085,023 and KRW 883,014. The average fiscal return on investment from smoking cessation for all age groups was estimated at 1.27.  Conclusions: Investing in smoking cessation was estimated to have positive fiscal returns for the government due to reduced mortality, morbidity, increased productivity and wages. Although ROI declined by age, reduced smoking prevalence generated significant per person tax revenue gains for government across all ages. After factoring in expected tobacco tax revenue loss from quitting smoking, the net tax revenue for the Korean government was positive. PRS6 Comparison of Health Care Utilization And Cost Depending on The Severity of Asthma in Adults: Analysis of The Korean National Health Insurance Claims Database Lee YJ, Lee E School of Pharmacy, Sungkyunkwan University, Suwon, South Korea

Objectives: This study attempts to estimate the proportion of patients, healthcare utilization, cost and frequency of acute exacerbations depending on the severity of asthma in adults using National Health Insurance(NHI) claims database.  Methods: NHI claims database (2014) has 3% of national patient sample which is extracted using a stratified randomized sampling method. Asthma patients were defined as those who were diagnosed with asthma in adults and prescribed more than one anti-asthma medications (n= 48,979 patients). Patients were divided into 3 different levels of asthma. In each 3 levels, we estimated acute exacerbations respectively, and the frequency and cost of acute exacerbations were compared.  Results: The result showed that 85.0% of patients were in level 1, 14.6% in level 2, and 0.4% in level 3. Also, the rate of steroid burst, visiting emergency department (ED), and hospitalization increased as the severity increased. Level 2 had 1.6 times more steroid burst, 3.7 times more ED visits, and 6.4 times more hospitalizations than level 1. Level 3 had 2.4 times more steroid burst, 3.8 times more ED visits, and 5.3 times more hospitalizations than level 2. There was a significant gap between level 1 and 3. The insured medical costs per visit were $22.7, $32.9, $37.8 (p< 0.0001) for steroid burst, and ED visit costs were $66.9, $103.1, $103.1 (p< 0.0001) in level 1, 2, 3 respectively. The cost of hospitalization were $1,286.1, $1,320.0, $1,915.0 (p< 0.0001) and period of being hospitalized were 9.1, 9.5, 14.1 days (p< 0.0001).  Conclusions: Health service utilization and cost per rate of acute exacerbations are related to the severity of asthma. The difference of cost for outpatient visits such as steroid bursts or ED visits was higher between level 1 and 2. Especially, the frequency of acute exacerbations, hospitalization cost and period were remarkably higher in level 3. Thus, asthma patients in level 3 should be aware of acute exacerbations and its prevention. PRS7 Direct Cost Analysis and Cost Effectiveness Analysis of Chronic Obstruction Pulmonary Disease in Fatmawati Public Hospital Anwar Y1, Afdhal AF1, Anggraini Y2 117 August 1945 Jakarta University, Jakarta, Indonesia, 2Pancasila University, Jakarta, Indonesia

Objectives: Chronic Obstruction Pulmonary Disease (COPD) is one of the world causes of morbidity and mortality. Level of COPD seriousness results in the increasing number of Length Of Stay (LOS) in the hospital. This research has been conducted in 2014 to analyse total direct cost and cost effectiveness analysis by the combination of ipratropium and salbutamol and single salbutamol on the COPD in Fatmawati Public Hospital Jakarta.  Methods: COPD patients who were hospitalized in Fatmawati Public Hospital between 1 January 2010 – 31 March 2014 were grouped according to the classification of COPD by Indonesian Pulmonary Doctor Association. Study design used was cross sectionaland retrospective. In addition, data were analyzed descriptively and calculating the Pearson correlation (r) that was conducted on the seriousness level of COPD on total direct cost. In addition, cost effectiveness of the combination of ipratropium and salbutamol therapy was compared to single salbutamol therapy on COPD patients.  Results: Among 237 patients of COPD, 122 patients with primary diagnosis and 115 patients with accompanying diagnosis. There were 97 patients who met inclusion criteria. The average total direct costs were IDR15,069,927.23. The highest cost was on cost of hospital stay, IDR5,106,409.99 (35,32%), followed by medicament cost IDR4,984,922.86 (32,51%). There was a very strong correlation (r =  0.876) between COPD seriousness level with the average direct total costs per year with or without comorbidity. COPD therapy, It has also shown, that cost and effectiveness were not significantly differed (p > 0.05) between salbutamol combination and single salbutamol.  Conclusions: In primary care, disease management should more focused on the holistic assessment

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and reduction of symptoms. For the future purposes treatment of COPD should follow the published guidelines for systematic diagnosis of symptoms and health status. This is important to improve the clinical outcome of individual and patients. PRS8 The Economic Burden Of Chronic Obstructive Pulmonary Disease In China: A Systematic Literature Review Qu KQ1, Selya-Hammer C2, Chew VC2 1Amaris, Toronto, ON, Canada, 2Amaris, London, UK

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality with high financial implications in China. There is an increasing public health concern for COPD due to increase in tobacco smoking and biomass fuel use and an aging population, and the direct and indirect costs are expected to continue rising. The aim of this study was to synthesize published economic studies evaluating healthcare resource use and its associated costs for COPD patients in China.  Methods: A systematic search was performed in Embase, Medline and Cochrane databases through March 2016 for studies reporting the economic burden of COPD. Articles were included if they provided information on the direct (outpatient, inpatient and medication) and indirect (transportation, nutrition and nursing) costs associated with COPD in China. Where possible, costs reported by the different studies were converted to 2015 US dollars using the consumer price index for medical care.  Results: Eleven economic studies were identified and included in this review. Most studies were retrospective database studies or surveys. Annual total costs ranged from $1964 to $3449 per patient, which would represent 33%-40% of average household income in China. Direct and indirect costs constituted between 85% to 88% and 12% to 15% of total costs respectively. Costs per patient increased with an increase in symptoms, severity, and duration of disease. Hospitalization owing to disease exacerbation was shown to be a major contributor to total costs.  Conclusions: COPD is associated with a high direct and indirect costs in China. Reducing hospitalization frequency represents one way to reduce the costs. This study highlights a need for strategies aimed at the prevention and management of COPD to reduce the economic burden in China. PRS9 Copd Uncovered: Health Care Resource Use and Cost of Chronic Obstructive Pulmonary Disease in Japan Igarashi A1, Fukuchi Y2, Hirata K3, Ichinose M4, Nagai A5, Nishimura M6, Lara N7, Murata S8, Gruenberger J9 1The University of Tokyo, Tokyo, Japan, 2Juntendo University Tokyo, Tokyo, Japan, 3Osaka City University, Osaka, Japan, 4Tohoku University, Sendai, Japan, 5ShinYurigaoka General Hospital, Kawasaki, Japan, 6Hokkaido University, Sapporo, Japan, 7IMS Health, Barcelona, Spain, 8Novartis Pharma, K.K., Tokyo, Japan, 9Novartis Pharma, AG, Basel, Switzerland

Objectives: Chronic obstructive pulmonary disease (COPD) remains a major public health problem in Japan. The aim of the study was to estimate healthcare resource use and the costs associated with COPD in a real-world setting. Methods: A 2 years retrospective chart review was conducted in 18 sites distributed across Japan, including patients >  40 years with spirometry confirmed COPD, and current or former smokers. Patients had to have available medical chart in the participating center for at least the previous 24 months with a minimum set of information. Patients having participated in a clinical trial during the previous 24 months were excluded. Demographic, COPD related clinical data and healthcare resource use (hospitalization, consultations, medication and visit to emergency room) were obtained from clinical charts.  Results: A total of 71 patients < 65 years old and 151 patients ≥ 65 years old were included, of whom 84.5% and 95.4% were males, respectively. At inclusion the mean (SD) FEV1/FVC ratio was 0.5 (0.1) and 0.5 (0.2) for patients <  65 and ≥ 65 years respectively. During the 2 year review period, 77,5% of patients < 65 years visited a respiratory specialist with a mean (SD) of 16,27 (8,47) visits. In the ≥ 65 years age group, 77.5% of patients had at least 1 visit to a respiratory specialist, with a mean (SD) of 20.81 (10.87) visits. The mean (SD) length of stay upon hospitalization (days per patient) was found to be 16.67 (13.84) and 18.03 (12.40) in the < 65 years and ≥ 65 years age groups, respectively. The mean (SD) annual cost per patient in the < 65 years and ≥ 65 years age groups was ¥438,976 (534,379) [US$ 4,390 (5,344.)] and ¥467,872. (606,121.) [US$ 4,677(6,061)], respectively.  Conclusions: COPD represents an important burden on health care system in Japan.

PRS10 Hospital Resource Utlization of Patients Over 40 Years old with Chronic Obstructive Pulmonary Disease in South Korea Umareddy I1, Hyunjung A2, Jieun K2 1Kantar Health, Singapore, Singapore, 2Kantar Health Korea, Seoul, The Democratic People’s Republic of Korea

Objectives: Chronic obstructive pulmonary disease is a leading cause of morbidity and associated healthcare resource utilisation globally and its burden is expected to increase in the rapidly aging nation of South Korea. The aim of this study is to investigate the burden of health care resource utilisation by COPD patients in S.Korea and the associated direct medical costs.  Methods: This was a retrospective observational study of data from the National Patient Sample (NPS) data from the Health Insurance Review and Assessment Service (HIRA) for the year 2014. COPD Patients over 40 years of age were identified by searching on ICD-10 codes as well as usage of and COPD medication and/or systemic steroid usage within a hospital setting. Resource use for COPD was measured by number and length of hospital stays, number of emergency room and out-patient visits and the associated costs were assessed. Linear regression modelling is used to explore the impact of comorbidities on total health-care costs, adjusting for age, sex and geographic location.  Results: The number of COPD patients in Korea was