Rune Nielsen

Present and future costs of COPD in Iceland and Norway: Results from the BOLD study

The Burden of Obstructive Lung Disease (BOLD) initiative provides standardised estimates of the burden of chronic obstructive pulmonary disease (COPD) worldwide. We estimate the current and future economic burden of COPD in Reykjavik, Iceland and Bergen, Norway using data from the BOLD initiative. Data on utilisation of healthcare resources were gathered from the BOLD survey, existing literature and unit costs from national sources. Economic data were applied to a Markov model using transition probabilities derived from Framingham data. Sensitivity analyses were conducted varying unit costs, utilisation and prevalence of disease. The cost of COPD was \#8364;478 per patient per yr in Iceland and \#8364;284 per patient per yr in Norway. The estimated cumulative costs of COPD for the population aged ≥40 yrs, were \#8364;130 million and \#8364;1,539 million for the following 10 yrs in Iceland and Norway, respectively. Costs of COPD accounted for 1.2 and 0.7% of healthcare budgets in Iceland and Norway, respectively. Sensitivity analyses showed estimates were most sensitive to changes in exacerbation frequency. COPD has a significant economic burden in both Iceland and Norway and will grow in the future. Interventions aimed at avoiding exacerbations will have the most impact on costs of COPD over the next 20 yrs.

The impact of COPD on health status: Findings from the BOLD study

The aim of this study was to describe the impact of chronic obstructive pulmonary disease (COPD) on health status in the Burden of Obstructive Lung Disease (BOLD) populations. We conducted a cross-sectional, general population-based survey in 11 985 subjects from 17 countries. We measured spirometric lung function and assessed health status using the Short Form 12 questionnaire. The physical and mental health component scores were calculated. Subjects with COPD (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.70, n = 2269) had lower physical component scores (44±10 versus 48±10 units, p<0.0001) and mental health component scores (51±10 versus 52±10 units, p = 0.005) than subjects without COPD. The effect of reported heart disease, hypertension and diabetes on physical health component scores (-3 to -4 units) was considerably less than the effect of COPD Global Initiative for Chronic Obstructive Lung Disease grade 3 (-8 units) or 4 (-11 units). Dyspnoea was the most important determinant of a low physical and mental health component scores. In addition, lower forced expiratory volume in 1 s, chronic cough, chronic phlegm and the presence of comorbidities were all associated with a lower physical health component score. COPD is associated with poorer health status but the effect is stronger on the physical than the mental aspects of health status. Severe COPD has a greater negative impact on health status than self-reported cardiovascular disease and diabetes. COPD is related to worse health status: impairment is greater than in self-reported cardiovascular diseases or diabetes http://ow.ly/p1cIx

Excessive costs of COPD in ever-smokers. A longitudinal community study.

AIM We aimed to estimate the societal treatment-related costs of COPD in hospital- and population-based subjects with spirometry defined COPD, relative to a control group. METHODS 81 COPD cases and 132 controls without COPD were randomly recruited from a general population, as were 205 COPD patients from a hospital register. All participants were ever-smokers of at least 40 years of age, followed for 12 months. Data on comorbid conditions and spirometry were collected at baseline. Standardized telephone interviews every third month gave information on use of healthcare services and exacerbations of respiratory symptoms. RESULTS The increased (excessive) median annual costs per case having stage II, stage III and stage IV COPD were € (95% CI) 400 (105-695), 1918 (1268-2569) and 1870 (1031-2709), respectively, compared to the population-based controls. Costs increased with €81 (95% CI 50-112) per exacerbation of respiratory symptoms and €461 (95% CI 354-567) per comorbid condition. Excessive costs for hospital COPD patients were threefold that of the population-based COPD cases. CONCLUSION The excessive treatment-related cost of COPD stage II+ in ever-smokers of at least 40 years was estimated to €105 million for Norway. Comorbidity was a dominant predictor of excessive cost in COPD.

ADRB2 Gly16Arg polymorphism, asthma control and lung function decline.

Arg/Arg homozygotes for the Gly16Arg polymorphism in the &bgr;2-adrenoreceptor gene (ADRB2) have a reduced response to short-acting &bgr;2-agonists but no effect has been associated with long-acting &bgr;2-agonists (LABAs). We selected 604 subjects with current asthma from the European Community Respiratory Health Study to evaluate whether asthma control and lung function decline were associated with Gly16Arg polymorphism, and to test whether LABA or inhaled corticosteroid (ICS) use modified these effects. There was an increased risk of noncontrolled asthma (OR 1.33, 95% CI 1.01–1.75; p=0.046) for each Arg allele. Among nonusers of ICS, the odds ratio of noncontrolled asthma among Arg/Arg versus Gly/Gly subjects was 2.73 (95% CI 1.28–5.82; p=0.009). No increased risk of noncontrolled asthma associated with the Arg allele was observed among ICS and/or LABA users. For each Arg allele, a mean±se decrease in decline in forced expiratory volume in 1 s of 7.7±2.5 mL·yr−1 was found (p-value for trend 0.003), irrespective of ICS or LABA use. Arg/Arg subjects had an increased risk of bronchial hyperresponsiveness (BHR) versus Gly/Gly subjects, with an odds ratio of 2.51 (95% CI 1.12–5.63; p=0.025) if they did not use ICS. The Arg allele was associated with poorer asthma control, a steeper lung function decline and BHR. Absence of genotypic effects on asthma control among ICS users may be due to reversed &bgr;2-adrenoreceptor desensitisation.

Sex-related differences in respiratory symptoms : results from the BOLD Study

For the same degree of lung function impairment females tend to report more (severe) dyspnoea and cough, but less phlegm http://ow.ly/mp2CF

Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high-and low-income sites

BACKGROUND Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low- and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations. METHODS We estimated rates of regular use of bronchodilators, inhaled corticosteroids and influenza vaccine, and predictors for use among 19 000 adults in 23 high-income countries (HICs) and LMIC sites. RESULTS Bronchodilators, inhaled corticosteroids and influenza vaccine were used significantly more in HICs than in LMICs, after adjusting for similar clinical needs. Although they are used more commonly by people with symptomatic or severe respiratory disease, the gap between HICs and LMICs is not explained by the prevalence of chronic obstructive pulmonary disease or doctor-diagnosed asthma. Site-specific factors are likely to influence use differently. The gross national income per capita for the country is a strong predictor for use of these treatments, suggesting that economics influence under-treatment. CONCLUSION We still need a better understanding of determinants for the low use of essential respiratory medicines and influenza vaccine in low-income settings. Identifying and addressing these more systematically could improve the access and use of effective treatments.

Aspects of healthcare utilisation in self-reported obstructive lung disease

Introduction:  Utilisation of healthcare resources because of pulmonary diseases have previously been presented according to lung function or symptom severity. We aimed to compare the associations of symptoms and lung function to healthcare and social service utilisation in subjects with self‐reported obstructive lung diseases (OLDs) (asthma, chronic obstructive pulmonary disease, chronic bronchitis, emphysema).

Repeatability of health economic data in COPD.

BACKGROUND Little is known concerning the precision of self-reported health economic data. AIM To investigate the repeatability of self-reported health economic cost and utilization data in subjects with chronic obstructive pulmonary disease (COPD). METHODS Twelve weeks after inclusion, a physician and a nurse in random order interviewed 29 subjects with post-bronchodilator COPD included from a research registry of COPD patients. The interview recorded healthcare utilization and costs, sick leave, exacerbations and quality of life (QoL). Variation of individual agreement of observations was described estimating kappa statistics and 95% limits of agreement. RESULTS Mean age was 63 years (standard deviation (SD) 10) and 17 participants were men. Average FEV(1)% predicted was 56% (SD 15). For sick leave, exacerbation, healthcare provider visit, change of medication, assistance and leisure time the kappa values were 1.00, 0.73, 0.73, 0.66, 0.63 and 0.54, respectively. The physician recorded fewer days of exacerbation and fewer contacts with healthcare providers than the nurse (p=0.01 and p=0.05, respectively). The 95% limits of agreement for costs of drugs were -690 to +710 Norwegian Kroner (NOK), -1200 to +899 NOK for costs of healthcare providers and -20 to +26 for QoL as measured by a visual analogue scale. CONCLUSION Repeatability of economic data from COPD patients showed considerable variation. This issue should be addressed when analyzing cost data from interviews and when designing studies on health economy.

Cryopreservation of osteo-chondral grafts in rabbits.

To study the cryopreservation of osteoarticular allografts, a lateral femoral condyle of the rabbit was transplanted fresh, after uncontrolled freezing to -80 degrees C with 4 weeks preservation, and after freezing 1 degree C per min to -100 degrees C in 10 per cent dimethylsulphoxide medium with 4-week storage in liquid nitrogen. Autografts were used as controls. After 3 months, the incorporation of the grafted bone was good in all technically successful cases. The NADH2 diaphorase activity and 35S sulphate uptake indicated well-functioning chondrocytes in all autografts. In the allografts, areas lacking enzyme activity and lacking 35S uptake were observed in cartilages with otherwise normally functioning chondrocytes. No differences were found between the three allograft groups. We conclude that freezing permits reasonably good short-term bank preservation of cartilage. We found no difference between conventional freezing and controlled slow freezing with preservative.

Economics of COPD: literature review and experiences from field work

Introduction:  The burden of diseases should be described in terms of costs. The available literature gives imprecise estimates of costs of chronic obstructive pulmonary disease (COPD) in the Nordic populations. Previous studies have methodological weaknesses related to choice of disease criteria, the use of highly selected populations and insufficient specification of the cost process. There are no robust estimates concerning the economics of COPD in Norway.