ARTICLE OPEN
Annual cos s o ch onic obs uc i e pulmona y disease in
Finland du ing 1996–2006 and a p edic ion model o
2007–2030
F ed ik He se
1
, Toni Kiljande
2
and Lau i Leh imäki
3,4
BACKGROUND: Ch onic obs uc i e pulmona y disease (COPD) is a majo bu den o he heal h ca e sys em, bu he exac cos s a e
di ficul o es ima e and he e a e insu ficien da a a ailable on pas and u u e ime ends o COPD- ela ed cos s.
AIMS: The aim o he s udy was o calcula e COPD- ela ed cos s in Finland du ing he yea s 1996–2006 and es ima e u u e cos s o
he yea s 2007–2030.
METHODS: COPD- ela ed di ec and indi ec cos s in he public heal h ca e sec o o he whole o Finland du ing he yea s
1996–2006 we e e ie ed om na ional egis e s. In addi ion, we made a ma hema ical p edic ion model on COPD cos s o he
yea s 2007–2030 on he basis o popula ion p ojec ion and changes in smoking habi s.
RESULTS: The o al annual COPD- ela ed cos s amoun ed o abou 100–110 million Eu os in 1996–2006, wi h no ob ious change,
bu he e was a sligh dec ease in di ec cos s and an inc ease in indi ec cos s du ing hese yea s. The es ima ion model p edic ed
a 60% inc ease up o 166 million Eu os in COPD- ela ed annual cos s by he yea 2030. This is caused almos en i ely by an inc ease
in di ec heal h ca e cos s ha eflec he p edic ed ageing o he Finnish popula ion, as olde age is a significan ac o ha
inc eases he need o hospi alisa ion.
CONCLUSIONS: The o al annual COPD- ela ed cos s in Finland ha e been s able du ing he yea s 1996–2006, bu i
managemen s a egies a e no changed a significan inc ease in di ec cos s is expec ed by he yea 2030 due o ageing
o he popula ion.
npj P ima y Ca e Respi a o y Medicine (2015) 25, 15015; doi:10.1038/npjpc m.2015.15; published online 26 Ma ch 2015
INTRODUCTION
Ch onic obs uc i e pulmona y disease (COPD) is highly p e alen
wo ldwide, and i is es ima ed o become he hi d mos common
cause o dea h globally by he yea 2020.
1
The p e alence o
COPD in he Finnish adul popula ion is abou 4–10% depending
on he defini ion used.
2–4
In wo ecen popula ion-based s udies,
he p e alence o COPD, as defined by pos -b onchodila o
a io o o ced expi a o y olume in 1 s o o ced i al capaci y
o0.7, was 9.4% among 21–70-yea -old subjec s in No he n
Finland
2
and 5.9% among 26–74-yea -old subjec s in Helsinki.
4
O he la e popula ion, 0.6% had se e e, 3.0% had mode a e
and 2.2% had mild COPD. These figu es a e oughly in line
wi h hose published in e na ionally,
5
bu e en highe figu es
ha e been epo ed in, e.g., No he n Sweden
6
and Denma k.
7
Al hough he age-adjus ed p e alence o COPD has no changed
du ing he las ew decades in Finland,
3
he o e all incidence
and p e alence o COPD may inc ease due o ageing o he
popula ion.
COPD is a majo disease in economic e ms as well. The di ec
annual heal h ca e cos s o COPD in he Eu opean Union a e
es ima ed o be abou 23.3 billion Eu os.
8
A la ge sha e o his is
hough o be caused by hospi alisa ions due o acu e exace ba-
ions o COPD. Como bidi ies ela ed o COPD u he inc ease he
o al cos s, bu hei e ec s a e di ficul o es ima e. As COPD-
ela ed heal h ca e cos s a e associa ed wi h he se e i y o he
disease, ea ly diagnosis and smoking cessa ion is ad oca ed o
hinde he disease p og ession
1
and he eby hope ully also
dec ease heal h ca e cos s.
New d ugs, such as long-ac ing b onchodila o s, ha e been
in oduced o he ea men o COPD du ing he las wo
decades. The use o hese d ugs inc eases he di ec medicinal
cos s o COPD. Howe e , as he d ugs imp o e heal h s a us in
subjec s wi h COPD,
1
hey migh in u n dec ease he cos s caused
by ou pa ien isi s. Mos impo an ly, he d ugs a e also shown o
dec ease he isk o acu e exace ba ions and hospi alisa ions,
1
and his migh be an impo an ac o in dec easing he o al
COPD- ela ed cos s. Fu he , changes in ea men p o ocols o
hospi alised pa ien s owa ds sho e in-hospi al pe iods a e likely
o a ec he o al cos s. Un o una ely, i is no well known how
hese ac o s ha e changed he COPD- ela ed heal h ca e cos s on
a na ionwide basis. The Finnish heal h ca e sys em wi h i s
comp ehensi e s a is ics o e s a good oppo uni y o es ima ing
COPD- ela ed cos s and he e ec s o he abo e-men ioned
pa ame e s on he cos s.
The aims o he cu en s udy we e o s udy he change in
o al na ional COPD- ela ed cos s in Finland du ing he yea s
1996–2006 and es ima e he u u e annual COPD- ela ed cos s in
Finland o he yea s 2007–2030. The s udy was conduc ed by he
No dic Heal h Ca e G oup and i was unded by Boeh inge -
Ingelheim Finland.
1
No dic Heal hca e G oup, Helsinki, Finland;
2
Depa men o Respi a o y Diseases, Te eys alo Hospi al, Tu ku, Finland;
3
School o Medicine, Uni e si y o Tampe e, Tampe e,
Finland and
4
Alle gy Cen e, Tampe e Uni e si y Hospi al, Tampe e, Finland.
Co espondence: L Leh imäki (lau i.leh imaki@u a.fi)
Recei ed 20 Janua y 2015; accep ed 27 Janua y 2015
www.na u e.com/npjpc m
All igh s ese ed 2055-1010/15
© 2015 P ima y Ca e Respi a o y Socie y UK/Macmillan Publishe s Limi ed
MATERIALS AND METHODS
Annual cos s 1996–2006
The annual cos s o COPD du ing he yea s 1996–2006 we e calcula ed
using heal h ca e egis e s and s a is ics co e ing he whole popula ion in
Finland (5.1 million people in 1996 and 5.3 million in 2006). The di ec cos s
o COPD we e ega ded as cos s caused by hospi alisa ions due o COPD,
ou pa ien isi s due o COPD and he cos s o COPD medica ion. The
indi ec cos s o COPD included sickness allowances and disabili y
pensions due o COPD. In con as o some o he s udies, we did no
fi s iden i y a ce ain popula ion o subjec s wi h COPD and hen add up
all hei heal h ca e cos s om egis e s using hei pe sonal iden i y codes.
Ins ead, we u ilised na ional egis e s o di e en heal h ca e se ices o
social benefi s and iden ified all such e en s whe e COPD was labelled as
he cause o ha se ice/benefi .
Di ec cos s
Cos s o hospi alisa ions and ou pa ien isi s: The co e o he Finnish
heal h ca e sys em is public heal h ca e, which consis s o p ima y (bo h
ou pa ien s and inpa ien s) and seconda y heal h ca e (bo h ou pa ien s
and inpa ien s) se ices. All ou pa ien isi s, hospi alisa ions and medical
p ocedu es in seconda y public heal h ca e and hospi alisa ions in p ima y
heal h ca e a e egis e ed wi h he ela ed ICD-10 diagnosis code by he
Na ional Ins i u e o Heal h and Wel a e.
9
The cos s o p i a e heal h ca e
o occupa ional heal h ca e sys ems we e excluded, as no egis e da a o
COPD pa ien s ea ed in hose sec o s could be ob ained.
We included in he analysis all ou pa ien isi s, days in hospi al and
medical p ocedu es wi h ICD-10 diagnos ic codes J43 (emphysema) o J44
(COPD) as he p ima y cause. The uni cos s in 2006 o a day in hospi al
and o an ou pa ien isi we e ob ained om he Na ional Ins i u e o
Heal h and Wel a e
10
and a e gi en in Table 1. The p icing o medical
p ocedu es was based on a e age DRG p ices quo ed by hospi als.
10
The
uni cos s o o he yea s we e de i ed om hese by using infla ion
co ec ions wi h p ice index on public expendi u e p o ided by S a is ics
Finland.
11
Medica ion cos s: In Finland, all d ugs bough om pha macies a e
egis e ed wi h he buye s' iden i y o he Finnish S a is ics on Medicines,
12
bu his egis e does no include he diagnos ic codes. Howe e , pa ien s
wi h se e e enough as hma o COPD gain a special eimbu semen o
hei medica ion. I a pe son en i led o such a eimbu semen buys
medica ion, da a on his can be e ie ed om he egis e s. Subjec s wi h
as hma and COPD a e no sepa a ed in his egis e bu a e conside ed a
single g oup o pa ien s wi h obs uc i e pulmona y diseases. To a oid
including medica ion used o ea as hma, we defined COPD- ela ed
d ugs as d ugs o he ea men o espi a o y diseases bough by pe sons
who we e en i led o a special eimbu semen o obs uc i e pulmona y
diseases and who also used inhaled an icholine gics ( hese we e only
seldom used o ea as hma in Finland du ing 1996–2006). The cos s o
hese COPD- ela ed d ugs we e gained om he Finnish S a is ics on
Medicines.
12
Indi ec cos s. Indi ec cos s o COPD, i.e., he loss o p oduc i i y due o
illness, we e calcula ed on he basis o sickness allowances and disabili y
pensions due o COPD. In Finland, all sickness allowances wi h he ICD-10
code o he cause a e egis e ed by he Social Insu ance Ins i u ion,
13
and
disabili y pensions wi h he ICD-10 code o he cause a e egis e ed by he
Finnish Cen e o Pensions.
14
The da a we e ie ed om he egis e s
included he numbe o days on sickness allowance and he numbe o
subjec s on disabili y pension due o COPD (J33 o J44). These we e hen
ans o med in o los man-yea s, and he cos s o hese we e calcula ed
using he uni cos , quo ed by he Na ional Ins i u e o Heal h and Wel a e,
o 24,600€pe yea in 2006.
10
Mo ali y caused by COPD was no included in he calcula ions o loss o
p oduc i i y, as mos COPD- ela ed dea hs occu a olde age when he
subjec has al eady e i ed. We excluded also he ollowing indi ec cos s
ha a e di ficul o define and calcula e: impai ed p oduc i i y a wo k
while s ill p esen (p esen eism),
15
wo k ou side o paid wo k, ca e-gi ing
by amily membe s and imma e ial cos s, he loss o p oduc i i y o
dec ease in e i emen pensions due o mo ali y caused by COPD.
Es ima ed annual cos s o 2007–2030
The es ima ion model was buil on an assump ion ha smoking his o y,
age and sex a e he majo ac o s de e mining ( he isk o COPD and)
COPD- ela ed cos s. In his model, we did no y o es ima e he ac ual
numbe o subjec s wi h COPD, bu ou model assumes ha he ac ions
o ac i e smoke s and ecen qui e s ha ha e COPD and cause
COPD- ela ed cos s emain he same in he u u e.
Fi s , we assessed he o al COPD- ela ed cos s in 2006, as desc ibed in
he fi s pa o he manusc ip , sepa a ely in each age g oup (5-yea
in e als) in bo h sexes. Second, we e ie ed he pe cen ages o ac i e
smoke s and ecen qui e s (du ing he p e ious 10 yea s) sepa a ely in
each co esponding age g oup and bo h sexes om he Tobacco S a is ics
in Finland.
16
We hen calcula ed in each age g oup and sex ‘smoking
s anda dised COPD cos s’in 2006 by di iding he ac ual COPD- ela ed
cos s in 2006 by he numbe o ac i e smoke s and ecen qui e s wi h he
ollowing weighing ac o s: 1 o ac i e smoke s and hose ex-smoke s who
had qui 1–3 yea s ago; 0.75 o ex-smoke s who had qui 3–5 yea s ago;
and 0.5 o ex-smoke s who had qui 5–10 yea s ago.
To calcula e he COPD- ela ed cos s in each age g oup and gende in he
yea s 2007–2030, we needed o calcula e he numbe s o smoking subjec s
and ecen qui e s in each age g oup and gende in each o he yea s. We
began by calcula ing he pe cen ages o ac i e smoke s and ecen
qui e s in each age g oup and sex o each yea om 2007 o 2030 by
assuming ha he ac ions o ac i e smoke s and ecen qui e s
(1–3 yea s ago, 3–5 yea s ago and 5–10 yea s ago) con inue o change
a he same a e hey ha e changed du ing he yea s 1996–2006 in Finland
based on he Tobacco S a is ics.
16
We hen mul iplied hese pe cen ages o
smoke s and ecen qui e s by he es ima ed numbe s o subjec s in each
age g oup and sex e ie ed om he popula ion p ojec ion in Finland
17
o
ge he ac ual numbe s o smoke s and ecen qui e s in each g oup and
yea . Finally, hese numbe s o ac i e smoke s and ecen qui e s in each
age g oup, sex and yea we e mul iplied by he ‘smoking s anda dised
COPD cos s’in 2006 using he same weighing ac o s o smoke s and
qui e s as men ioned abo e. These o al annual COPD- ela ed cos s
du ing he yea s 2007–2030 we e hen co ec ed by an assumed annual
infla ion ac o o 2%.
RESULTS
Annual cos s 1996–2006
The numbe s o ou pa ien isi s, days in hospi al, days on sickness
allowance and sickness pensions e ie ed om he egis e s a e
gi en in Table 2, bo h in absolu e alues and also pe 100,000
inhabi an s. The e was a 17% inc ease in p ima y ca e hospi al
Table 1. The uni cos s o heal h ca e se ices and cos o los
man-yea s due o sickness allowance o disabili y pension ob ained
om he Na ional Ins i u e o Heal h and Wel a e in he yea 2006
Uni cos , €
Days in hospi al in p ima y ca e 142
Days in hospi al in seconda y ca e 590
Seconda y ca e ou pa ien isi s 200
Los man-yea due o sickness allowance o
disabili y pension
24,600
Table 2. Numbe s o hospi alisa ion days, ou pa ien isi s, days on
sickness allowance and subjec s on disabili y pension e ie ed om
egis e s in 1996 and 2006
1996 2006
Popula ion in Finland 5,132,320 5,276,955
Days in hospi al in p ima y ca e 58,986 (1,149) 69,021 (1,308)
Days in hospi al in seconda y ca e 68,231 (1,329) 32,446 (615)
Seconda y ca e ou pa ien isi s 22,179 (432) 20,115 (381)
Days on sickness allowance due
o COPD
59,104 (1,152) 64,354 (1,220)
Subjec s on disabili y pension due
o COPD
1,928 (38) 1,844 (35)
The numbe s a e in o al alues in Finland and pe 100,000 inhabi an s in
pa en hesis.
Abb e ia ion: COPD, ch onic obs uc i e pulmona y disease.
Cos o COPD on he inc ease in Finland
F He se e al
2
npj P ima y Ca e Respi a o y Medicine (2015) 15015 © 2015 P ima y Ca e Respi a o y Socie y UK/Macmillan Publishe s Limi ed
days bu a simul aneous 52% dec ease in mo e expensi e
seconda y ca e hospi al days. Changes in ou pa ien isi s, days
on sickness allowances and pe sons on disabili y pensions we e
no ma ked.
The ime ends o key COPD- ela ed cos s in he pe iod 1996–
2006 a e p esen ed in Figu e 1, and he exac numbe s in o al and
pe 100,000 inhabi an s in he yea s 1996 and 2006 a e gi en in
Table 3. The annual o al COPD- ela ed cos s in Finland a ied
be ween 101 and 110 million Eu os du ing he pe iod 1996–2006
and he e was no ob ious change (Figu e 1). Howe e , he e was a
sligh dec ease in di ec cos s om 63.6 o 56.3 million Eu os and a
simila sligh inc ease in indi ec cos s om 46.5 o 51.4 million
Eu os du ing hese yea s (Table 3). The dec ease in di ec cos s
was caused by educed numbe o days in hospi al in seconda y
ca e causing a ma ked dec ease in cos s o abou 16 million Eu os.
Howe e , his was somewha ou weighed by a simul aneous
inc ease in medica ion cos s o abou 6 million Eu os and by
smalle inc eases in o he di ec cos s. The ise in indi ec cos s
was caused mainly by inc ease in uni cos s o los p oduc i i y, as
he e we e no ma ked changes in he days on sickness lea e o
subjec s on disabili y pension (Table 2).
Es ima ed annual cos s o 2007–2030
On he basis o ou calcula ions, he annual COPD- ela ed cos s in
Finland will inc ease by abou 60% du ing he yea s 2007–2030
om 107 o 166 million Eu os (Figu e 2). The main eason o his
inc ease is he significan ageing o he Finnish popula ion in he
yea s o come, as bo h he p e alence o COPD and especially
he use o heal h ca e se ices inc ease wi h ageing. E en he
dec easing end in he ac ion o smoke s does no seem o
balance ou he e ec o ageing. This ageing- ela ed inc ease in
o al cos s is caused almos en i ely by inc easing di ec cos s
(hospi alisa ions, ou pa ien isi s and medical cos s). The indi ec
cos s will no change subs an ially du ing he yea s 2007–2030, as
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Cos s o disabili y pensions
Cos s o sickness allowances
Cos s o medica ion
Inpa ien episode cos s, p ima y heal h
Inpa ien episode cos s, seconda y
heal h ca e
Ou pa ien isi cos s, seconda y
heal h ca e
Yea
Cos s (€)
Di ec cos s Indi ec cos s
Figu e 1. To al COPD- ela ed cos s in Finland du ing he yea s 1996–2006 e ie ed om na ional egis e s and di ided in o majo
componen s. COPD, ch onic obs uc i e pulmona y disease.
Table 3. Di ec and indi ec cos s o COPD in he whole popula ion o Finland in he yea s 1996 and 2006, bo h in absolu e alues and pe 100,000
inhabi an s
1996 2006
To al cos s (€) Cos s pe 100,000 inhabi an s (€) To al cos s (€) Cos s pe 100,000 inhabi an s (€)
Ou pa ien isi cos s, SHC 3,890,214 75,798 4,023,000 76,237
Hospi alisa ion cos s, SHC 35,321,979 688,226 19,154,939 362,992
Hospi alisa ion cos s, PHC 7,371,664 143,632 9,835,330 186,383
Cos s o medica ion 17,046,441 332,139 23,268,935 440,954
To al di ec cos s 63,630,298 1,239,796 56,282,204 1,066,566
Cos s o sickness allowances 4,897,021 95,415 6,074,400 115,112
Cos s o disabili y pensions 41,592,319 810,400 45,348,966 859,378
To al indi ec cos s 46,489,340 905,815 51,423,366 974,489
To al cos s 110,119,638 2,145,611 107,705,570 2,041,055
Abb e ia ions: COPD, ch onic obs uc i e pulmona y disease; PHC, p ima y heal h ca e; SHC, seconda y heal h ca e.
Cos o COPD on he inc ease in Finland
F He se e al
3
© 2015 P ima y Ca e Respi a o y Socie y UK/Macmillan Publishe s Limi ed npj P ima y Ca e Respi a o y Medicine (2015) 15015
inc eased mo bidi y a olde age, when al eady e i ed om wo k,
does no a ec he p oduc i i y.
DISCUSSION
Main findings
The main findings o he s udy we e ha he o al COPD- ela ed
cos s in Finland we e s able a abou 100 million Eu os annually
du ing he yea s 1996–2006, bu due o he o hcoming ageing o
he popula ion he annual cos s a e es ima ed o inc ease by
abou 60% by he yea 2030.
In e p e a ion o findings in ela ion o p e iously published wo k
Cos -o -illness s udies can be di ided in o wo ypes: op-down
s udies, like his one, es ima ing o al cos s on he basis o he
egis e da a on a na ional le el, and bo om-up s udies ha
ollow indi idual pa ien s eco ding all hei cos s and hen
ex apola ing hese o na ional le el by aking in o accoun
disease p e alence. Top-down s udies gene ally include a limi ed
numbe o di e en cos s and hey exclude unde diagnosing,
whe eas bo om-up s udies include cos s o como bidi ies as well,
and he p edic ion o o al na ional cos s is dependen on he
accu acy o p e alence es ima es. These issues mus be aken in o
conside a ion when compa ing di e en s udies.
A Swedish op-down s udy
18
es ima ed ha in 1991 he o al
COPD- ela ed cos in Sweden was abou 3.2 million Eu os pe
100,000 inhabi an s (2,784 million SEK (Swedish K ona) in o al,
1€≈10 SEK and Sweden’s popula ion was abou 8.6 million in
1991). This es ima e is somewha highe han ou es ima e o o al
COPD- ela ed cos s in Finland in he yea 1996 (2.1 million Eu os
pe 100,000 inhabi an s). This di e ence may be, in pa , explained
by he ac ha he Swedish s udy also es ima ed mo ali y- ela ed
cos s and by he ac ha he mean leng h o hospi alisa ion may
ha e dec eased al eady be ween 1991 and 1996 in bo h he
coun ies. A mo e ecen s udy om Sweden
19
ga e a much
highe es ima e o he o al COPD- ela ed cos s, o alling 15.7
million Eu os pe 100,000 inhabi an s (1.46 billion Eu os in o al;
Swedish popula ion 9.3 million in 2010), bu his may be explained
by he bo om-up design o he s udy. In Denma k in he yea
2002, COPD- ela ed cos s we e es ima ed by a op-down s udy
20
o be 4.7 million Eu os pe 100,000 inhabi an s (256 million Eu os
in o al; Danish popula ion 5.4 million in 2002), which is mo e in
he same ange wi h ou s udy and he op-down s udy om
Sweden.
A p e ious s udy in Finland epo ed ha he annual cos s o
COPD we e 194 million Eu os.
21
The di e ence om ou esul
(abou 100 million) may be explained by he b oade spec um o
diagnos ic labels included in he p e ious s udy (also J40–J42
(ch onic b onchi is) and J47 (b onchiec asis)) in e ie ing heal h
ca e u ilisa ion da a om he egis e s. Fu he mo e, he p e ious
s udy calcula ed hospi al ea men o be caused by COPD e en i
COPD was no he p ima y diagnosis, whe eas he cu en s udy
included only hose ea men pe iods in which COPD was
labelled as he p ima y cause o hospi alisa ion. Including only
ea men pe iods wi h COPD as he p ima y diagnosis may
unde es ima e he cos s caused by acu e exace ba ions o COPD,
as some o hese pe iods may be labelled wi h a diagnosis o
acu e b onchi is o pneumonia. On he o he hand, conside ing
ha all ea men pe iods a e caused by COPD, whe e COPD is
included in he lis o he pa ien ’s diagnoses, su ely causes
o e es ima ion o COPD- ela ed cos s, as hese subjec s a e
ea ed o o he diseases as well. Such di e ences be ween
s udies make i di ficul o compa e he esul s.
A p e ious s udy
22
has es ima ed ha COPD- ela ed cos s in
Finland ha e dec eased by 88% om 1997 o 2007. Howe e , he
cos s a di e en ime poin s we e e ie ed om di e en s udies
wi h conside able di e ences in he calcula ion me hods used.
This se e ely unde mines he eliabili y o he s a ed huge
dec ease in COPD- ela ed cos s. To ou knowledge, he cu en
s udy is he fi s using he same me hods consis en ly in assessing
he annual COPD- ela ed cos s in Finland du ing a wide ange o
yea s. We ound ha he e was no ob ious change in o al COPD-
ela ed cos s du ing he pe iod 1996–2006.
Al hough he o al COPD- ela ed cos s we e s able du ing he
yea s 1996–2006, he e was a dec ease in he di ec cos s and a
co esponding inc ease in he indi ec cos s. The di ec cos s
dec eased mainly due o a dec ease in he numbe o in-hospi al
days. This eflec s changes in clinical p ac ice ega ding he
ea men o acu e exace ba ions o COPD. The numbe o hospi al
ea men pe iods was abou he same in 1996 and 2006, bu he
mean leng h o he ea men pe iods dec eased, which also
dec eased he o al numbe o ea men days. Ou finding is in
line wi h a ecen epo om Sweden
19
in which cos s o
hospi alisa ions due o COPD dec eased be ween he yea s 1999
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
140,000,000
160,000,000
180,000,000
200,000,000
Yea
Cos s (€)
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Figu e 2. P edic ed o al COPD- ela ed cos s in Finland du ing he yea s 2007–2030 di ided in o di ec (open ba s) and indi ec (ha ched ba s)
cos s. COPD, ch onic obs uc i e pulmona y disease.
Cos o COPD on he inc ease in Finland
F He se e al
4
npj P ima y Ca e Respi a o y Medicine (2015) 15015 © 2015 P ima y Ca e Respi a o y Socie y UK/Macmillan Publishe s Limi ed
and 2010 bu he e was a simul aneous inc ease in
medica ion cos s.
The e a e no many p edic ion s udies o u u e COPD cos s
a ailable in e na ionally, bu a ecen s udy
23
es ima ed a 53%
inc ease in na ional COPD cos s in he Uni ed S a es om 32.1
billion dolla s in 2010 o 49 billion dolla s by he yea 2020. This is
in line wi h ou es ima e o a 60% inc ease in COPD cos s by he
yea 2030 in Finland.
S eng hs and limi a ions o his s udy
This s udy is based on na ional egis e s co e ing he public heal h
ca e sys em in he whole o Finland and gi es a eliable es ima e
on he ue cos s o COPD. Howe e , ou es ima e o o al cos s is
likely a conse a i e one because o se e al easons. Fi s , he
exac eason and p ima y diagnosis o hospi alisa ion o a subjec
wi h COPD and many como bidi ies is no always s aigh o wa d,
and some exace ba ions o COPD a e ce ainly ea ed unde o he
diagnoses, which may lead o unde es ima ion o hospi alisa ion
cos s. Second, ou pa ien isi s in p i a e heal h ca e sys ems o in
p ima y public heal h ca e could no be included because o lack
o eliable egis e s. Howe e , his is p obably no a significan
issue, as he cos s o ou pa ien isi s a e small when compa ed
wi h hospi alisa ions and indi ec cos s, and he numbe o isi s
o elde ly people in p i a e heal h ca e is e y small. Thi d, no all
pa ien s wi h mild o mode a e COPD ha e a special eimbu se-
men o medica ion, and he medica ion cos s o subjec s wi hou
his eimbu semen a e no included in his analysis. As
medica ion cos s a e highe in subjec s wi h se e e COPD, his
may no be a ma ked flaw bu leads o unde es ima ion in any
case. Fu he mo e, he indi ec cos s a e always di ficul o define
and calcula e, and we did no include, e.g., he possibili y ha
mo ali y due o COPD migh dec ease he expenses o e i emen
pensions due o ea lie dea h o subjec s wi h COPD.
Ou es ima e o u u e cos s assumes ha he e ec i eness o
he heal h ca e sys em and he age-adjus ed need o hospi alisa-
ion will be a he cu en le el in he u u e also. Howe e , i new
ea men s eme ge ha significan ly dec ease he need o
hospi alisa ion o sho en hospi alisa ion pe iods, he inc ease in
u u e cos s migh be smalle han es ima ed he e. Ou model on
he u u e p e alence o COPD also assumed ha he age-
adjus ed p opo ion o smoke s in he popula ion will con inue o
dec ease a he same a e as i has in p e ious yea s. I he
smoking ends de ia e om he assump ion ei he up- o
downwa ds, his migh dec ease he liabili y o ou es ima e on
he p e alence o COPD. Howe e , he e is a conside able la ency
pe iod be ween changes in smoking habi s and changes in COPD
p e alence, and ou ime pe iod o he es ima e is only 24 yea s.
The e o e, he accu acy in p edic ing u u e smoking habi s is no
ha impo an o he ime pe iod o 24 yea s, bu i would be
much mo e pi o al o longe ime pe iods.
A weakness o he cu en s udy, as wi h all p edic ion models,
is ha in p edic ing u u e COPD- ela ed cos s we needed o
es ima e se e al pa ame e s on he basis o hei ime ends in
he pas . Howe e , while doing his we ied o be as ealis ic, o
e en conse a i e, as possible.
Implica ions o u u e esea ch, policy and p ac ice
In he pas , he p e alence o COPD has been on he ise due o
ageing o he popula ion, and he medicine cos s ha e also isen
as new d ugs ha e become a ailable. Howe e , hese ac o s
inc easing he cos s ha e been balanced ou by inc eased
e ficiency o he heal h ca e sys em ha has dec eased he leng h
o in-hospi al pe iods. The Finnish popula ion will be ageing
much mo e apidly du ing he nex 20 yea s han du ing he yea s
1996–2006. The numbe o pa ien s wi h COPD will inc ease
especially in he olde age g oups, in which also he need
o hospi al ea men is he g ea es . This is why he e will be
ageing- ela ed inc ease in o al COPD- ela ed cos s in he u u e,
al hough his did no ake place in he pas . As he olde age
g oups ha e al eady e i ed, he highe p e alence o COPD
among hese subjec s does no cause an inc ease in indi ec cos s
ha a e ela ed o loss o p oduc i i y.
The ageing- ela ed inc ease in COPD cos s should be aken in o
accoun in Finland when planning he na ional heal h ca e
s a egy. The esul s can be expanded o o he wes e n coun ies
wi h simila smoking habi s and ageing o he popula ion. As he
s eamlining o he heal h ca e sys em in ea ing exace ba ions
has al eady aken place, his is likely no a significan op ion in
educing he cos s anymo e. Ins ead, ocus should be on smoking
policy o dec ease age-adjus ed COPD incidence and on he
managemen o s able COPD o dec ease he isk o
exace ba ions.
Conclusions
In conclusion, he annual cos s o COPD in Finland ha e been
s able du ing he yea s 1996–2006, bu he cos s a e es ima ed o
inc ease by 60% un il he yea 2030 mainly due o ageing o he
popula ion. A s ic smoking policy is needed o dec ease COPD-
ela ed mo bidi y and he u u e ise in cos s, and possible new
ea men op ions need o be assessed in e ms o cos
e ec i eness as well.
CONTRIBUTIONS
All he au ho s ook pa in planning he s udy and w i ing he manusc ip . FH was
esponsible o e ie ing he da a om heal h ca e da abases and o analysing
he da a.
COMPETING INTERESTS
The au ho s decla e no conflic o in e es .
FUNDING
The s udy was unded by Boeh inge -Ingelheim Finland.
REFERENCES
1 Global Ini ia i e o Ch onic Obs uc i e Lung Disease (GOLD). Global S a egy o
he Diagnosis, Managemen and P e en ion o COPD 2014. A ailable a h p://
www.goldcopd.o g/.
2 Ko aniemi J, So ijä i A, Lundbäck B. Ch onic obs uc i e pulmona y disease in
Finland: p e alence and isk ac o s. COPD 2005; 2: 331–339.
3 Vasanka i TM, Impi aa a O, Heliö aa a M, Heis a o S, Liippo K, Puukka P e al. No
inc ease in he p e alence o COPD in wo decades. Eu Respi J 2010; 36:
766–773.
4 Kainu A, Rouhos A, So ijä i A, Lindq is A, Sa na S, Lundbäck B. COPD in Helsinki,
Finland: socioeconomic s a us based on occupa ion has an impo an impac on
p e alence. Scand J Public Heal h 2013; 41:570–578.
5 Halbe RJ, Na oli JL, Gano A, Badamga a E, Buis AS, Mannino DM. Global
bu den o COPD: sys ema ic e iew and me a-analysis. Eu Respi J 2006; 28:
523–532.
6 Lundbäck B, Lindbe g A, Linds öm M, Rönma k E, Jonsson AC, Jönsson E e al.
No 15 bu 50% o smoke s de elop COPD?--Repo om he Obs uc i e Lung
Disease in No he n Sweden S udies. Respi Med 2003; 97:115–122.
7 Hansen JG, Pede sen L, O e ad K, Omland O, Jensen HK, So ensen HT. The
p e alence o ch onic obs uc i e pulmona y disease among Danes aged 45-84
yea s: popula ion-based s udy. COPD 2008; 5: 347–352.
8 Gibson GJ, Loddenkempe R, Lundback B, Sibille Y. Respi a o y heal h and
disease in Eu ope: he new Eu opean Lung Whi e Book. Eu Respi J 2013; 42:
559–563.
9 Na ional Ins i u e o Heal h and Wel a e. Ca e Regis e o Heal h Ca e 2014.
A ailable a h p://www. hl.fi/en_US/web/en/s a is ics/da a_collec ion.
10 Hujanen T, Kapiainen S, Tuominen U, Peku inen M. Te eydenhuollon Yksikkö-
kus annukse Suomesssa Vuonna 2006. S akes: Helsinki, Finland, 2008.
11 O ficial S a is ics o Finland (OSF). P ice index o public expendi u e [e-publica-
ion] 2014. A ailable a h p://www.s a .fi/ il/jmhi/index_en.h ml.
Cos o COPD on he inc ease in Finland
F He se e al
5
© 2015 P ima y Ca e Respi a o y Socie y UK/Macmillan Publishe s Limi ed npj P ima y Ca e Respi a o y Medicine (2015) 15015

12 The Social Insu ance Ins i u ion o Finland. Finnish S a is ics on Medicines 2014.
A ailable a h p://www.kela.fi/ ilas ojulkaisu _suomen-laake ilas o.
13 The Social Insu ance Ins i u ion o Finland. S a is ics on Sickness Allowance 2014.
A ailable a h p://www.kela.fi/web/en/s a is ics-by- opic_s a is ics-on-sickness-
allowance.
14 The Social Insu ance Ins i u ion o Finland. S a is ics on pensions 2014. A ailable
a h p://www.kela.fi/web/en/s a is ics-by- opic_s a is ics-on-pension-in-finland.
15 D ummond M. Me hods o he economic e alua ion o heal h ca e p og ammes.
In: Sculphe M, To ence G, O´B ian B, S odda d G (eds). Basic Types o Economic
E alua ion. Ox o d Uni e si y P ess: Ox o d, UK, 2005, 7–25.
16 O ficial S a is ics o Finland (OSF). Tobacco s a is ics [e-publica ion] 2014. A ail-
able a h p://s a .fi/ il/ upk/index_en.h ml.
17 O ficial S a is ics o Finland (OSF). Popula ion p ojec ion [e-publica ion] 2014.
A ailable a h p://www. ilas okeskus.fi/ il/ aenn/index_en.h ml.
18 Jacobson L, He zman P, Lö dahl CG, Skoogh BE, Lindg en B. The economic
impac o as hma and ch onic obs uc i e pulmona y disease (COPD) in Sweden
in 1980 and 1991. Respi Med 2000; 94: 247–255.
19 Jansson SA, Backman H, S enling A, Lindbe g A, Rönma k E, Lundbäck B. Heal h
economic cos s o COPD in Sweden by disease se e i y—has i changed du ing a
en yea s pe iod? Respi Med 2013; 107: 1931–1938.
20 Bilde L, Rud S enning A, Dolle up J, Baekke Bo gesko H, Lange P.
The cos o ea ing pa ien s wi h COPD in Denma k—a popula ion s udy o
COPD pa ien s compa ed wi h non-COPD con ols. Respi Med 2007; 101:
539–546.
21 Tynkkynen L, Klaukka T, Pie inalho A, Rissanen P. The cos s o ch onic obs uc i e
pulmona y disease a e lowe han p e iously expec ed. Finn Med J 2009; 64:
2095–2099.
22 Kinnula VL, Vasanka i T, Kon ula E, So ijä i A, Säynäjäkangas O, Pie inalho A. The
10-yea COPD P og amme in Finland: e ec s on quali y o diagnosis, smoking,
p e alence, hospi al admissions and mo ali y. P im Ca e Respi J 2011; 20:
178–183.
23 Fo d ES, Mu phy LB, Kha jou O, Giles WH, Hol JB, C o JB. To al and s a e-specific
medical and absen eeism cos s o ch onic obs uc i e pulmona y disease among
adul s aged ⩾18 yea s in he Uni ed S a es o 2010 and p ojec ions
h ough 2020. Ches 2015; 147:31–45.
This wo k is licensed unde a C ea i e Commons A ibu ion 4.0
In e na ional License. The images o o he hi d pa y ma e ial in his
a icle a e included in he a icle’s C ea i e Commons license, unless indica ed
o he wise in he c edi line; i he ma e ial is no included unde he C ea i e Commons
license, use s will need o ob ain pe mission om he license holde o ep oduce
he ma e ial. To iew a copy o his license, isi h p://c ea i ecommons.o g/licenses/
by/4.0/
Cos o COPD on he inc ease in Finland
F He se e al
6
npj P ima y Ca e Respi a o y Medicine (2015) 15015 © 2015 P ima y Ca e Respi a o y Socie y UK/Macmillan Publishe s Limi ed