Potential clinical and economic impact of optimised maintenance therapy on discharged patients with COPD after hospitalisation for an exacerbation in China

BMJ Open. 2021 Apr 28;11(4):e043664. doi: 10.1136/bmjopen-2020-043664.


Objectives: Chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalisation are a considerable burden, both clinically and economically. Although long-acting maintenance therapy is recommended in both the GOLD (Global Initiative for Chronic Obstructive Lung Disease) and Chinese COPD guidelines, proper implementation is lacking. The objective of this study was to assess the clinical and economic impact of prescribing long-acting maintenance therapy to discharged patients with COPD after hospitalisation for an exacerbation in China by using an outcomes model.

Design: This health economic analysis was conducted using a Markov cohort model from the Chinese healthcare payer perspective. Two health states (alive and dead) were modelled, and exacerbations were included as possible events.

Setting: The target population was Chinese patients with COPD, >40 years of age, who were hospitalised for an exacerbation, with 1 year of follow-up. A recent COPD national prevalence study was referenced for population calculations.

Intervention: A hypothetical future scenario, where 100% of patients would receive long-acting maintenance therapy after hospitalisation for an exacerbation, was compared with the current scenario, in which only 38.5% of patients are receiving long-acting maintenance therapy after hospitalisation.

Outcome measures: Number of exacerbations, deaths and medical costs were measured.

Results: We estimated that there were approximately 4 million Chinese patients with COPD who were hospitalised annually due to an exacerbation. By prescribing long-acting maintenance therapy, our model predicted that 917 360 exacerbations and 4034 deaths could be avoided, translating into cost savings of ¥3.5 billion (US$0.5 billion). Scenario analysis also showed that if the rate of exacerbations requiring hospitalisation was higher than our base case analysis, cost savings could reach up to ¥10.7 billion (US$1.5 billion).

Conclusion: Administering long-acting maintenance therapy to more patients with COPD at hospital discharge could considerably reduce exacerbations and healthcare spending in China.

Keywords: chronic airways disease; health economics; quality in health care; thoracic medicine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China
  • Cost Savings
  • Disease Progression
  • Hospitalization
  • Humans
  • Patient Discharge*
  • Pulmonary Disease, Chronic Obstructive* / drug therapy