<p>Comparative analysis of medical expenditure with nebulized budesonide versus systemic corticosteroids in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease in China</p>

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population. Patients and methods: A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received “any” nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission. Results: The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen ( P =0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure ( P <0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS ( P =0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen ( P =0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%; P =0.2299). Conclusion: AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.

Economic Burden of Chronic Obstructive Pulmonary Disease: A Systematic Review

“…This research found a link between the more significant reported burden of COPD (breathlessness, symptoms, and comorbidities) and higher overall societal expenses per patient [ 26 , 59 , 77 , 78 ]. Thus, the severity of the disease and symptoms might be one of the factors that influence the economic burden of COPD.…”

“…In terms of components of the nonmedical direct cost, we discovered differences between studies. There were also cost-effectiveness studies; therefore, there were differences in treatment techniques [ 26 , 47 ]. Results showed that, direct costs are much higher in developed countries than in developing countries.…”

“…In our dataset, four studies were conducted in lower-middle- and low-income countries [ 30 , 34 , 36 , 40 ], and seven for the upper-income countries [ 26 , 29 , 51 , 72 , 73 ]. Similar to results of several previous studies, these findings emphasize the lack of research on the economic costs of COPD in developing countries [ 26 ]. Probably due to human resources, finance, and infrastructure limitations in these countries [ 70 ].…”

AECOPD research in the past ten years: a bibliographic analysis based on Web of Science

“…Acute exacerbations of COPD (AECOPD) can cause a significant decrease in lung function of patients and seriously affect the health and life of patients. It is the main reason for the hospitalization and death of COPD patients and places a heavy burden on the patient's family and the medical system (6,7). Therefore, AECOPD has been the focus of research in respiratory diseases in recent years (8)(9)(10)(11)(12).…”

<p>Optimization of Nebulized Budesonide in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease</p>

“…[17][18][19][20] Recently, clinical studies and Metaanalysis have shown that nebulized budesonide (NB) is as effective as systemic corticosteroids in controlling nonacidotic AECOPD, as evaluated by clinical symptoms, lung function, and blood gas analysis. Furthermore, NB treatment reduces side effects [17][18][19][20][21][22] and medicine costs 23 compared to systemic corticosteroids. GOLD guidelines suggest NB as a suitable alternative to systemic corticosteroids in the treatment of exacerbations in some patients.…”