Assessment of the Economic Burden and Quality of Life in Patients With Chronic Obstructive Pulmonary Disease*

Technical Summary: Assessment of the Economic Burden and Quality of Life in Patients With Chronic Obstructive Pulmonary Disease

Problem Statement
Chronic Obstructive Pulmonary Disease (COPD) represents a dual challenge: a progressive clinical condition and a substantial economic and social burden. While the clinical progression of COPD is well-documented, there is a need to comprehensively evaluate its specific impact on health-related quality of life (HRQoL) and the associated economic costs from multiple perspectives. In Türkiye, COPD accounts for approximately 4% of all deaths and affects roughly 6.5% of the population, with higher prevalence among women (7.8%) than men (5.2%). The disease imposes costs through direct medical expenditures (hospitalizations, medications), direct non-medical costs (transportation, nutrition), and indirect costs (productivity loss). This study addresses the gap in understanding the interplay between disease severity, quality of life, and economic burden specifically within the context of Bitlis Province, Türkiye, a region with distinct environmental risk factors such as tandoor oven usage.

Methodology
The research employed a descriptive, cross-sectional design involving a census of the target population rather than sampling.

• Study Population: The study included 1,683 COPD patients (89.9% of the identified population) who applied to seven public hospitals in Bitlis Province in 2022. Inclusion criteria required residence within the province, voluntary participation, and the absence of mental disorders preventing questionnaire completion.
• Data Collection: Data were gathered via hospital records and structured face-to-face or telephone interviews between May and October 2023.
• Instruments:
  • Quality of Life: Assessed using the St. George's Respiratory Questionnaire (SGRQ), the EQ-5D-5L Health Questionnaire (utilizing German value sets for Türkiye), and the COPD Assessment Test (CAT).
  • Economic Burden: Calculated from three perspectives: (1) Patient and Caregiver (out-of-pocket, non-medical, income loss), (2) Payer/Reimbursement Institution (Social Security Institution invoices), and (3) Societal (sum of all direct and indirect costs).
  • Costing Approach: A "bottom-up" approach was used to estimate costs based on individual patient data. Costs were calculated in Turkish Lira (TL) and converted to USD using the 2022 average exchange rate (1 USD = 16.6185 TL).
• Statistical Analysis: Data were analyzed using SPSS version 22.0. Parametric tests (t-tests, ANOVA) were used for group comparisons, Pearson correlation for relationships between variables, and simple linear regression to determine the impact of disease severity (SGRQ) on quality of life and costs. A budget impact analysis was conducted using 2022 population data and projections for 2040 and 2069.

Key Results

• Demographics and Clinical Profile: The cohort was predominantly male (63.5%) with a mean age of 66.5 years. A striking 93% of participants had at least one comorbid disease (most commonly hypertension, heart disease, and diabetes). 78.9% of women reported using traditional tandoor ovens.
• Quality of Life: Participants exhibited impaired health-related quality of life. The mean CAT score was 25.97 (indicating high symptom burden). The EQ-5D index score was 0.44, and the EQ-VAS score was 41.05. The mean SGRQ total score was 68.07.
  • Correlations: There was a significant negative correlation between disease severity (CAT/SGRQ scores) and quality of life (EQ-5D/EQ-VAS). Conversely, disease severity showed a positive correlation with economic costs.
  • Group Differences: Women, inpatients, those with risk factors, those with a family history of COPD, and those with a history of COVID-19 infection demonstrated significantly worse quality of life scores compared to their counterparts.
• Economic Burden:
  • Average Costs: The mean total cost was 697.11 TL ($6.96) for outpatients and 9,530.32 TL ($573.48) for inpatients. Direct medical costs constituted the largest proportion of expenses.
  • Sensitivity Analysis: Tornado diagrams identified "transportation" as the most impactful cost component from the patient/caregiver perspective, and "treatment" costs as the most impactful from the reimbursement institution perspective.
  • Budget Impact: From the societal perspective, COPD accounted for 0.64% of total health expenditures for outpatients and 8.70% for inpatients. The total societal cost for all COPD patients was estimated at 13.25 billion TL (2.18% of total health expenditures).
  • Projections: Based on population growth, the number of COPD patients is projected to rise to over 6.5 million by 2040, with inpatient societal costs estimated to reach over 62 billion TL.

Key Contributions

• Integrated Assessment: This study is one of the first in the region to simultaneously evaluate disease-specific quality of life and economic burden across three distinct economic perspectives (patient, payer, and society) for COPD.
• Regional Specificity: It provides granular data on the impact of specific local risk factors, such as tandoor oven usage among women, on disease severity and economic outcomes.
• Quantification of Burden: The study quantifies the share of COPD in the national health budget, highlighting that while per-patient costs in Türkiye are lower than in developed nations due to public financing, the aggregate burden is significant and growing.
• Correlation Evidence: It empirically demonstrates that as disease severity increases (higher CAT/SGRQ scores), quality of life declines and economic costs rise, validating the need for interventions that target both clinical symptoms and economic sustainability.

Significance and Claims
The authors claim that COPD is not merely a clinical condition but a serious economic and social burden that requires multidimensional management strategies. The study highlights that the high prevalence of comorbidities and specific environmental exposures (smoking, tandoor smoke) in the study region contribute to a severe clinical picture and reduced quality of life.

The paper concludes that strengthening smoking cessation programs, reducing environmental risk factors (specifically tandoor smoke exposure), and expanding early diagnosis and rehabilitation services are essential to alleviate this burden. The authors suggest that policies focusing on rational drug use, transportation assistance for patients, and national awareness campaigns could improve quality of life and reduce the economic strain on the healthcare system. The study positions itself as a foundational step for future multicenter research to better assess the clinical and economic burden of COPD across diverse regions.