Clinical and economic consequences associated with expanding drug reimbursement for patients with chronic obstructive pulmonary disease

Objective. To evaluate clinical and economic impact of cost reimbursement for treatment with dual and triple fixed-dose therapeutic combinations in adults with moderate, severe, and very severe chronic obstructive pulmonary disease (COPD). Material and methods. A decision-analytic model was developed to evaluate clinical and economic outcomes associated with two alternative strategies of pharmacological coverage in COPD. The model estimated changes in the number of moderate and severe exacerbations and COPD-related mortality (including working-age population) following broader implementation of reimbursed maintenance therapy. Economic evaluation included: (1) direct medical costs—pharmacotherapy expenditures, costs of outpatient and inpatient management, emergency medical services; (2) indirect costs — GDP losses caused by premature mortality and productivity losses caused by exacerbation-related withdrawal from the workforce. Results. Expanding pharmacotherapy coverage had led to reductions in moderate exacerbations by 14% and severe exacerbations by 13%. Lower incidence of exacerbation led to reductions in outpatient visits, emergency medical services, admissions and associated direct medical costs. Over the year, the number of deaths among patients decreased by 6% that translated into estimated reduction in GDP losses by approximately 10.6 billion over a 10-year period when examining of working-age cohort. Conclusion. Expansion of reimbursed maintenance pharmacotherapy in outpatient setting, despite higher upfront medication expenditures, could be associated with fewer COPD exacerbations, reduced healthcare resource utilization, and substantial reductions in direct medical and indirect societal costs.