Abstract
OBJECTIVE: To evaluate the consumption of the direct health resources of primary care (PC) in Spain by a cohort of patients with chronic bronchial pathology: chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). DESIGN: Prospective cohort study of patients with CB and COPD monitored in PC in Spain. The first 10 adult patients who attended at random each researcher's clinic and who were diagnosed as suffering an exacerbation of their chronic bronchial pathology were included. Scheduled follow-up visits for a year evaluated the cohort's consumption of health resources. Direct health costs were analysed. RESULTS: 268 doctors, with 2414 patients, took part. 1510 patients completed the 12 months follow-up (62.6%). All the patients received pharmacological treatment for their pulmonary disease. The most common complementary investigations performed were: general blood analysis (1.5 per patient/year), chest x-ray (1.2) and ECG (0.9), followed by spirometry (0.5) and arterial gasometry (0.4). Mean number of exacerbations per year were 1.9; and admissions, 0.2. Overall cost, including tests, medical visits, hospital expenditure and pharmacological treatment, was 420,264,000 pesetas for the entire cohort. The direct annual cost per patient ran at 278,321 pesetas. The cost caused by patients treated with Cefixime on the first exacerbations was 77,365 pesetas less, which was mostly due to less hospital expense. CONCLUSIONS: The direct annual cost per patient with CB or COPD is high, above the cost of other chronic respiratory pathologies such as bronchial asthma. There are notably greater hospital costs for CB and COPD, explained by these patients' mean greater age and the non-reversible and progressive deterioration of their respiratory function.