The Economic Burden Of Chronic Obstructive Pulmonary Disease (COPD) In Shanghai And The Feasibility Of 3D Reconstruction Using Low-dose CT Scan In Diagnosis And Classification Of COPD

Partâ… The economic burden of Chronic Obstructive Pulmonary Disease(COPD) in ShanghaiObjective: To investigate the times of doctors' office visiting and the total costs for chronic obstructive pulmonary disease (COPD) in one year in Shanghai with its expenditure constitution. To analyze the standardization and rationality of the direct expense and its constitution in COPD in order to provide the theory evidence for COPD- related health policy.Methods: There were 100 COPD patients included inpatients and outpatients or long-term follow-up ones during Sep 1^st 2008 and March 31^st 2009 in Zhongshan Hospital Fudan University. They were divided into moderate group,severe group and very severe group by 2006 GOLD COPD guide. Collected all patients' clinical data, and calculated the times of doctors' office visiting and the total costs spent for COPD with its cost constitution in one year. Compared the difference in the times of doctors' office visiting and the total costs with the expenditure constitution between the three groups. Analyzed the correlation between economic burden and the severity of COPD. Calculated the times of inspections usually used in COPD such as spirometry,thorax CT scan and chest X-ray, meanwhile analyzed the proportion of the costs of these inspections to total inspections' expenditure.Results: Totally 83 patients who met the roll-in and roll-out criteria were collected the whole one year medical history. They were all male and beyond 40 years old. The mean age of 83 subjects was (70±9)y and the mean amount of cigarette was (37.9±21.5)pack/year. There was no difference on the age and the amount of cigarette between the three groups. Further results as follow:1.BMI of very severe COPD patients (21.4±2.6) was lower than moderate (23.5±3.1) and severe (23.4±3.8) patients (P value respectively 0.010 and 0.023). There was no difference between moderate and severe COPD patients (P>0.05).2.The total direct costs,pharmaceutical costs,ventilation costs,bed costs in hospitalization,nursing care costs in hospitalization,the times of ICU and its expenditure had negative correlation with FEV₁%pred (P<0.05). The coefficient of correlation was respectively -0.938,-0.319,-0.277,-0.261,-0.255,-0.216 and -0.262. But the costs of inspections,diagnosis and treatment,I.V. solutions and nebulization therapy,oxygen therapy had no correlation with FEV₁%pred (P>0.05). As the same, the times and the costs of outpatient,emergency department and hospitalization had no correlation with FEV₁%pred (P>0.05).3. There was a significantly difference in total direct costs,pharmaceutical costs, bed and nursing care costs in hospitalization between the three groups (P<0.05). The total direct costs (ï¿¥8385±7716), pharmaceutical costs (ï¿¥6099±4940), bed costs (ï¿¥61±144) and nursing care costs (ï¿¥31±60) in hospitalization of very severe COPD patients were strikingly higher than moderate patients (ï¿¥4051±4716,ï¿¥2687±2755,ï¿¥18±83,ï¿¥9±42) and severe patients (ï¿¥4794±5690,ï¿¥3383±3331,ï¿¥21±94,ï¿¥8±35) (P<0.05). But there was no difference between moderate COPD patients and severe patients (P>0.05). The total direct costs,pharmaceutical costs and inspection costs in one year of very severe COPD patients were almostly 1.5-2 times the costs of moderate and severe patients'. But the costs of inspections , diagnosis and treatment , I.V. solutions and nebulization therapy, oxygen therapy, ventilation therapy and other expenditures had no difference between the three groups (P>0.05).4. The pharmaceutical costs were the biggest proportion in total direct costs. Its average was 70.8%. The proportion of inspections and oxygen therapy were 14.1% and 5.5% in turn. But the proportion of diagnosis and treatment were only 3.7%, and there was no difference between moderate and severe COPD patients (P>0.05). The proportion of I.V. solutions and nebulization therapy, ventilation therapy, bed costs and nursing care costs in hospitalization, and other expenditures in total inspections costs was respectively 2.1 %,0.8%,0.6%,0.3% and 2.2%.5.The times of severe AECOPD in very severe COPD patients (0.29±0.54) was significantly more than it in moderate (0.05±0.21) and severe patients (0.06±0.24) (P value respectively 0.053 and 0.034). The difference of the times of severe AECOPD was no statistical significance between severe patients and moderate patients, although severe group was more than moderate group (P>0.05).6. Almostly 12% (10/83) patients had medical history of severe AECOPD. Their total direct costs in one year (ï¿¥17711±7944) , pharmaceutical costs (ï¿¥11176±5348), inspections costs (ï¿¥3229±1257), costs of diagnosis and treatment (ï¿¥359±261) and times of spirometry (ï¿¥1.20±0.92) were all strikingly more than the patients without severe AECOPD (ï¿¥4178±4116,ï¿¥3148±2692,ï¿¥486±581,ï¿¥194±145 and 0.75±0.62) (P<0.05). The lung function of patients with severe AECOPD was worse than those without severe AECOPD (FEV₁%pred: 26.7±14.7 vs 40.1±13.9) (P<0.05).7. The times of spirometry,thorax CT scan and chest X-ray in each patient per year was respectively 0.81±0.67,0.48±0.67 and 0.40±0.64. There was no difference between the three groups in the times of spirometry,thorax CT scan and chest X-ray (P>0.05). The proportion of spirometry,thorax CT scan and chest X-ray in total inspection costs was respectively 17.8%,13.6% and 3.4%.Conclusion:1. The more COPD disease was severe, the more the patients spent the expenditures on the total direct costs for COPD,pharmaceutical costs, ventilation therapy,bed costs and nursing care costs in hospitalization,ICU costs and the times of ICU therapy. The total direct costs,pharmaceutical costs and inspection costs in one year of very severe COPD patients were almostly 1.5-2 times the costs of moderate and severe patients'.2. The proportion of expenditures on medical treatment was respectively pharmaceutical costs (70.8%),inspection costs (14.1%),oxygen therapy costs (5.5%) and costs of diagnosis and treatment (3.7%) in turn. The result suggested that current charges for diagnosis and treatment may be unreasonable.3. The patients with poorer lung function had more times of severe AECOPD. The expenditures on severe AECOPD increased corresponding to the severity of disease.4. The times of spirometry,thorax CT scan and chest X-ray in each patient per year was respectively 0.81±0.67,0.48±0.67 and 0.40±0.64.5. Because of the case quantity limited, it was necessary to further epidemiological investigation or multi-center studies to reflect the more exact social economic burden of COPD. Partâ…¡The Feasibility of 3D reconstruction using low-dose CT scan in diagnosis and classification of COPDObjective: In order to investigate the ability of the indexes of 3D reconstruction using low-dose CT scan(LDCT) to make out the patients with or without airflow obstruction and its severity degree. To analyze the feasibility of LDCT-3D reconstruction in diagnosis and classification of COPD.Methods: The subjects who met the roll-in and roll-out criteria were all COPD outpatients and physical check people during July 1^st 2008 and March 31^st 2009 in Zhongshan Hospital Fudan University. They were divided into non-COPD group and COPD group by 2006 GOLD COPD guide. Collected their clinical data and let them do the spirometry and thorax LDCT scan. Compared the indexes of spirometry such as FEV₁, FEV₁%pred, FVC, FEV₁/FVC, IC, IC%pred, TLC, FRC, RV, RV/TLV, DLCO%pred and KCO%pred, and the indexes of LDCT-3D reconstruction between non-COPD group and COPD group, such as emphysema index in inspiration/ expiration period (Elin & Elex), emphysema volume in inspiration/expiration period (EVin & EVex), and total lung volume in inspiration/ expiration period (TLVin & TLVex). Did correlation analysis and curve estimation using the indexes of spirometry and the indexes of LDCT-3D reconstruction. Analysed the best index to distinguish airflow obstruction by ROC curve. Estimated the goodness of fit in emphysema by visual criteria and emphysema index of LDCT-3D reconstruction.Results: Totally 31 subjects who met the roll-in and roll-out criteria finished spirometry and thorax LDCT scan. They were all male. The mean age of 23 subjects who belong to COPD group was (67.8±11.4) y. The other 8 subjects who belong to non-COPD group was (51.8±8.0) y. They had no difference on the amount of cigarette and BMI. The results of the indexes of spirometry and LDCT-3D reconstruction between these two groups as follow:1. Elin and Elex in COPD group and non-COPD group were respectively 12±5,5±2 and 8±4,2±1. EVin and EVex in COPD group and non-COPD group were respectively 433±196,289±132 and 193±65,76±32. EIin/EIex in COPD group and non-COPD group was respectively 1.5±0.4 and 2.4±1.1. EIin,EIex,EVin and EVex in COPD group were all higher than it in non-COPD group, meanwhile EIin/EIex in COPD group was lower than it in non-COPD group(P<0.01). But TLVin,TLVex,EIin-EIex,EVin-EVex,TLVin-TLVex and (EIin-EIex)/(TLVin-TLVex) had no difference between COPD group and non-COPD group(P>0.05).2.With the increase of COPD severity, EIin,EVin,EIex and EVex rose and Elin/ EIex grew down meanwhile. But the change had no statistical significance in different COPD severity group (P>0.05 by two-sample T test). It might be limited by sample size in different COPD severity degree.3. EIin had the negative correlation with FVC, FEV₁, FEV₁%pred, FEV₁/FVC, DLCO%pred and KCO%pred (P<0.01). The coefficient of correlation was -0.459, -0.639, -0.608, -0.732, -0.655 and -0.520. EVin had the negative correlation with FEV₁, FEV₁%pred, FEV₁/FVC, DLCO%pred and KCO%pred (P<0.01). The coefficient of correlation was -0.553, -0.547, -0.682, -0.662 and -0.644. EIex had the negative correlation with FVC, FEV₁, FEV₁%pred, FEVi/FVC, DLCO%pred and KCO%pred (P<0.01). The coefficient of correlation was -0.579, -0.740, -0.702, -0.788, -0.701 and -0.554. EVex had the negative correlation with FVC, FEV₁, FEV₁%pred, FEVi/FVC, DLCO%pred and KCO%pred (P<0.01). The coefficient of correlation was -0.509, -0.704, -0.673, -0.777, -0.739 and -0.645. EIin/EIex had the positive correlation with VC, FEV₁, FEV₁%pred, FEV₁/FVC and DLCO%pred (P<0.05). The coefficient of correlation was 0.537, 0.646, 0.577, 0.535 and 0.413. Meanwhile EIex and EVex had the positive correlation with RV/TLC%pred (P<0.05). The coefficient of correlation was 0.404 and 0.431. Other indexes of LDCT-3D reconstruction such as TLVin,TLVex,EIin-EIex,EVin-EVex and (EIin-EIex)/ (TLVin-TLVex) had no correlation with the indexes of spirometry (P>0.05).4. EIex had the best correlation with FEV₁/FVC and FEV₁%pred using Logarithmic model after curve estimation. The regression equation was as follow: FEV₁/FVC(%)=90.694-20.093*In(EIex); FEV₁%pred= 105.027-27.866*In(EIex). EIex had the best correlation with RV/TLC%pred using S model after curve estimation. The regression equation was that "RV/TLC%pred=e^{(4.937-0.624/EIex)}".5. EIex had the optimal power to distinguish whether the subjects had airflow obstruction or not by ROC curve analysis. When EIex was 3.75, its sensitivity was 91.3% and its specificity was 100%. So if EIex was higher than 3.75, the subjects was considered with airway obstruction.6. There were 25% subjects (2/8) with emphysema in non-COPD group, and 78.3% subjects (18/23) with emphysema in COPD group by visual criteria on LDCT scan(.P<0.05). Meanwhile there were 91.3% subjects (21/23) with airway obstruction in COPD group, and no subject with airway obstruction in non-COPD group (P<0.01). Visual criteria and EIex by LDCT-3D reconstruction had a goodness of fit in emphysema and airflow obstruction assessment. Its fitness coefficient was 0.64 (P<0.01).Conclusion:1. EIex had the difference between COPD group and non-COPD group (P<0.01). The change of EIex had no statistical significance in different COPD severity group (P>0.05 by two-sample T test). It might be limited by sample size in different COPD severity degree. So it was necessary to enlarge the quantity of COPD patients in order to analyse whether the indexes of LDCT-3D reconstruction could be used to classify the severity of COPD.2.EIex had the negative correlation with FVC, FEV₁, FEV₁%pred, FEV₁/FVC, DLCO%pred and KCO%pred (P<0.01). And it also had the positive correlation with RV/TLC%pred (P<0.05).3. There was a goodness of fit in emphysema and airflow obstruction assessment between visual criteria and EIex.4.EIex could be used to distinguish the airflow obstruction when 3.75 was as the cut-off point. EIex could estimate the severity of airway obstruction and emphysema by regression equation.5. Of all the indexes of LDCT-3D reconstruction, EIex might be the optimal method to diagnose COPD on early stage. But it still needed to enlarge the amount of sample size and observe a long-term follow-up in order to make sure about its accuracy.