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A one-way, static Markov model estimating the social and economic burden of chronic obstructive pulmonary disease in Bulgaria for patients who smoke or don't

Konstantin Tachkov, Konstantin Mitov, Alexandra Savova, Maria Kamusheva

Aims: We aimed at estimating the societal and economic burden of COPD in Bulgaria for the current prevalence and compare local to European trends.

Materials and Methods: Between 2015-2016 data on 426 patients was collected in an ambispective, representative national study for Bulgaria. We recorded the distribution of patients as per GOLD severity classification and calculated the costs of treatment. A one-way Markov model was constructed for the cohort, examining effectiveness of smoking cessation, mortality and value of life years saved. The model was transposed to the country’s entire COPD population (447,070) according to smoking status to evaluate the future economic burden and quality of life.

Results: Cost of therapy increased as disease progressed (438€ for GOLD A to 790€ for GOLD D (± 85.56)). 10-year mortality was higher for smokers (54.9% vs. 49.7%). The cohort model revealed lower costs and QALYs for smokers vs. non-smokers (1,520,560.4 BGN; 1786.8 vs. 1,866,675.18; 2146.9). Incremental ratios were 954.1 per QALY gained and 6530.46 per life year saved. The population estimates were approximately 1.1 billion BGN and 1,280,308 QALYs for smokers vs. 556 million BGN and 640,887 QALYs for non-smokers, with ICERs of 860.32 BGN per QALY gained and 8,441.82 per life year saved.

Conclusion: Non-smokers experience higher costs and higher quality of life. The majority of COPD patients in the general population smoke (310,465), accounting for nearly twice the cost of therapy than non-smokers (136,605), who live longer with better QoL. Smoking cessation campaigns could help lessen the health authority’s economic burden.