هزینه بیش از حد حاد موارد تشدید برونشیت مزمن در سن 45 و پیرتر در انگلستان و ولز

Introduction Chronic Bronchitis is a serious and costly health problem. Prevalence is estimated at 45 per 10,000 persons in the United Kingdom. Approximately £120,000 would be saved for every 100 hospital admissions avoided. A reduction in acute exacerbations of chronic bronchitis (AECB), treatment failures, and subsequent hospital admission could have a significant impact on the burden of AECB borne by secondary care facilities in the UK National Health Service (NHS). Objective The aim of this study is to provide an economic assessment of the direct cost to the health care system associated with the management of chronic bronchitis and its acute exacerbations. Design A prevalence-based, excess-cost-of-illness analysis is undertaken from the perspective of the UK NHS. Disease prevalence data, primary health care resource utilization, hospital inpatient and outpatient resource utilization, and costs of health care were taken from a variety of data sources, including a large UK national survey of general practice (GP) consultations, the General Practice Research Database, a survey from a single NHS hospital trust, and the national health-care resource and cost statistics. Results From 1994 to 1995, approximately 233,000 cases of chronic bronchitis were detected in the persons aged 45 and older in the United Kingdom. Prevalence peaked at 204 per 10,000 in the group of subjects aged 75 to 84 years. During that same period, the total excess cost of primary care associated with AECB was calculated at £35.7 million. The largest component of primary care costs was the excess cost of all prescription medicines, which totaled £27.8 million. The excess cost attributed to antibacterial and respiratory prescription medications alone was estimated at £9 million. Excess costs attributed to GP consultations and hospital emergency room visits were £6.5 million and £1.3 million, respectively. The excess costs arising from inpatient hospital episodes included £8.3 million for hospital admissions, £660,000 for outpatient costs, and £225,000 for day care. Conclusions These results suggest that improving the management of AECB with the objective of reducing the number of AECB treatment failures and the associated hospital admissions could significantly reduce expenditures by the UK NHS.

Chronic bronchitis, which forms part of the group of diseases classified as chronic obstructive pulmonary disease (COPD), is a major disease in its own right and has an estimated overall prevalence of 45 cases per 10,000 people in the United Kingdom. Prevalence increases with age, rising from approximately 7.5 per 10,000 in persons aged 25 to 44 years to over 65 per 10,000 in persons aged 45 to 64 years, and peaks at over 200 per 10,000 in persons aged 75 to 84 years. Although a 14% increase has been reported in the prevalence of all respiratory disorders during the 10-year periods from 1981/1982 to 1991/1992, the prevalence of chronic bronchitis has fallen by approximately 30% in males and approximately 10% in females [1]. Despite a decrease in prevalence, chronic bronchitis remains a serious health problem with a major economic impact on the health-care system. The diagnosis of chronic bronchitis is based on history and clinical assessment. The disease is highlyprevious bronchial infections. It is a chronic condition with recurrent exacerbations, the majority of which are caused by bacterial infection. Treatment of chronic bronchitis and the acute exacerbations of chronic bronchitis (AECB) is relatively straightforward, the first-line of treatment being antibacterial agents; however, increasing resistance to these agents has been noted [2]. Such resistance, which has been linked to the overall use of antibacterial drugs, can result in first-line treatment failure with a consequent impact on the management of AECB [3]. Possible causes of firstline treatment failure include inappropriate antibacterial treatment, either because an unsuitable antibiotic was chosen or an incorrect dosage was used. Treatment failure can lead to substantial health-care costs [4].

utilization arising from chronic bronchitis and consequent treatment failure. The overall aggregate cost amounted to approximately £45 million in the year 1994–1995 for our estimated patient population of about 233,000. This figure represents between 0.1% and 0.2% of the UK NHS budget. The aggregate consists of two elements, the excess cost of exacerbations, totaling £35.7 million; and the cost of treatment failure (defined as hospitalization), which totals £9.2 million. Whether all the excess cost of health care utilization can be attributed to chronic bronchitis is arguable. Given that the excess cost was dominated by excess prescription costs, we have also calculated an excess cost based solely on antibacterial and respiratory medications, which reduces the excess cost of primary care to around £9 million. This implies that patients with chronic bronchitis have excess comorbidities and associated prescription drug costs. A limitation of the present study was that the study population could not be separated into smokers and nonsmokers, given that the GPRD data did not always include this information. Analysis based on this characteristic would have been interesting, but the absence of this information may have been a major restriction. In the GP National Morbidity Survey researchers note that, although smoking is known to reduce life expectancy, their survey did not show a marked difference in GP consultation rates between smokers and nonsmokers [1]. In fact, for men, the likelihood of consulting during their survey period tended to be lower for smokers than for nonsmokers. For respiratory disorders, specifically, the odds ratio for smokers consulting as compared with nonsmokers was 0:9 for men and 1:1 for young females and 1:2 for elderly females. Therefore, the excess likelihood of health care utilization, at least in the primary sector, can be inferred to be broadly similar. Given that treatment failure was defined as hospitalization in our study, we must assume that such failure was as common for smokers as for nonsmokers.