Chest
Volume 124, Issue 3, September 2003, Pages 826-831
Journal home page for Chest

Clinical Investigations
COPD
Major Components of the Direct Medical Costs of α1-Antitrypsin Deficiency

https://doi.org/10.1378/chest.124.3.826Get rights and content

Study objectives:

To examine the sources of the direct medical costs of α1-antitrypsin (AAT) deficiency based on survey data from affected individuals.

Background:

Prior research has reported the total cost of AAT deficiency but has not examined the specific components of the direct medical costs of affected individuals.

Methods:

In order to detail the sources of the direct medical costs, we sent surveys to 688 respondents of a previous survey. We estimated the costs in three ways, which differed in the method of managing missing values. With method 1, the group mean value of cost per unit of utilization, multiplied by the occurrences of utilization, was used to replace the missing value. Two sensitivity analyses (ie, methods 2 and 3) were conducted to test the robustness of our estimate. With method 2, values of zero were entered for all missing values. With method 3, the missing values were replaced by the group mean value. The Wilcoxon test was used to test the cost differences between patients of different phenotypes. All cost data were expressed in 1998 US dollars.

Results and conclusions:

Two hundred ninety-two individuals responded to the survey. The annual total health-care costs were high (mean range, $36,471 to $46,114; median range, $12,485 to $37,100 [according to the method for managing missing data]) for AAT deficiency. The total costs for individuals with the PI*ZZ phenotype exceeded those for individuals with a non-PI*ZZ phenotype. The use of IV augmentation therapy accounted for more than half of all direct medical costs for the respondents. Besides the costs for therapy with α1-proteinase inhibitor (Prolastin; Bayer; West Haven, CT), other major cost sources were prescription drugs other than α1-proteinase inhibitor, hospitalization, health insurance, and physician visits.

Section snippets

Materials and Methods

In the current study, a questionnaire (available from Dr. Mullins on request) addressing the previous 12-month period was sent to the 688 respondents to our earlier report.3 The questionnaire addressed the following areas: demographic characteristics; utilization of health services due to AAT deficiency and other health problems; and treatment costs for AAT deficiency. Specifically, information was sought regarding costs due to the following: α1-proteinase inhibitor; health insurance premiums;

Results

Responses were received from 292 of the 688 individuals to whom questionnaires had been sent (42.4%). The response rates for PI*ZZ individuals was 42.7% vs 41.8% for non-PI*ZZ subjects. Of the 292 respondents, 23 were excluded from analysis (20 because the questionnaires lacked cost information, and 3 because the total cost estimates were outliers, exceeding the group mean values by 10 times the SD). Thus, the results presented are based on 269 respondents (39.1% of those persons who had been

Discussion

The results of this survey of direct health-care costs associated with AAT deficiency show the following: (1) annual total health-care costs are high (mean range, $36,471 to $46,114; median range, $12,485 to $37,100), with estimates varying (by up to 20.9 to 66.3%) according to the method used for managing missing data; (2) total costs for PI*ZZ individuals showed a trend to exceed those for non-PI*ZZ individuals; (3) the use of IV augmentation therapy accounted for more than half of all

References (15)

There are more references available in the full text version of this article.

Cited by (19)

  • Meeting the challenge of COPD care delivery in the USA: A multiprovider perspective

    2016, The Lancet Respiratory Medicine
    Citation Excerpt :

    More than two-thirds of both commercially insured and Medicare patients are routinely not prescribed any long-acting maintenance therapy.107 Additionally, access to and availability of augmentation therapy for some patients with α1 antitrypsin deficiency remain an issue.213 Patients with α1 antitrypsin deficiency incur approximately 6 times greater health-care costs than do COPD patients without such deficiency, with half of this cost being direct expenses associated with α1 antitrypsin augmentation.

  • Augmentation therapy of alpha-1 antitrypsin deficiency associated emphysema

    2015, Revue des Maladies Respiratoires
    Citation Excerpt :

    Randomised studies have demonstrated the efficacy of augmentation therapy on the decline in lung density. Augmentation therapy is a costly treatment (over 100 k€/year) and represents up to 60% of the medical costs for an emphysema patient in the United States [24]. The cost-effectiveness ratio is still debated.

  • Alpha-1 antitrypsin deficiency 50 years later

    2014, Bulletin de l'Academie Nationale de Medecine
  • AAT as a diagnostic tool

    2005, Clinica Chimica Acta
View all citing articles on Scopus

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail:[email protected]).

This research was funded by the Alpha-1 Foundation.

View full text