Obesity and overweight in Canada: an updated cost-of-illness study

This study is to update the estimates of the economic burden of illness because of overweight and obesity in Canada by incorporating the increase in prevalence of overweight and obesity, findings of new related comorbidities and rise in the national healthcare expenditure. The burden was estimated from a societal perspective using the prevalence-based cost-of-illness methodology. Results from a literature review of the risks of 18 related comorbidities were combined with prevalence of overweight and obesity in Canada to estimate the extent to which each comorbidity is attributable to overweight and obesity. The direct costs were extracted from the National Health Expenditure Database and allocated to each comorbidity using weights principally from the Economic Burden of Illness in Canada. The study showed that the total direct costs attributable to overweight and obesity in Canada were $6.0 billion in 2006, with 66% attributable to obesity. This corresponds to 4.1% of the total health expenditures in Canada in 2006. The inclusion of newly identified comorbidities increased the direct cost estimates of obesity by 25%, while the rise in national healthcare expenditure accounted for a 19% increase. Policies to reduce being overweight and obese could potentially save the Canadian healthcare system millions of dollars.     

The health care costs of diabetic nephropathy in the United States and the United Kingdom

PROBLEM: Diabetic nephropathy (DN) is a common microvascular complication of diabetes and can result in end-stage renal disease (ESRD) necessitating long-term dialysis or kidney transplantation. The costs of these complications are relatively high. The aim of this study was to quantify and compare the rates and annual costs of DN in the USA and the UK. METHODS: A cost of illness model was used to estimate the numbers of people with DN (microalbuminuria, overt nephropathy, and ESRD) or a previous kidney transplant at a given point in time and the numbers of new kidney transplants during a year. All costs were estimated in 2001 currencies. A sensitivity analysis assessed the robustness of the national annual cost estimates. RESULTS: In the USA, the total annual medical costs incurred by all payers in managing DN were US dollars 1.9 billion for Type 1 diabetes (range: US dollars 1.0-2.8 billion), US dollars 15.0 billion for Type 2 diabetes (range: US dollars 7.6-22.4 billion), and US dollars 16.8 billion for all diabetes (range: US dollars 8.5-25.2 billion). In the UK, the total annual costs to the National Health Service (NHS) of managing DN were US dollars 231 million ( pound 152 million) for Type 1 diabetes (range: US dollars 190-350 million [ pound 125-230 million]), US dollars 933 million (pound 614 million) for Type 2 diabetes (range: US dollars 809 million-US dollars 1.4 billion [pound 532-927 million]), and US dollars 1.2 billion ( pound 765 million) for all diabetes (range: US dollars 999 million-US dollars 1.8 billion [pound 657 million- pound 1.2 billion]). CONCLUSIONS: The total annual cost of DN is 13 times greater in the USA than in the UK. Controlling for the substantially higher number of people at risk, the total cost per person with DN and/or a kidney transplant is 40% higher: US dollars 3735 in the USA and US dollars 2672 (pound 1758) in the UK.     

Direct medical cost of overweight and obesity in the USA: a quantitative systematic review

To estimate per‐person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. PubMed (1968–2009), EconLit (1969–2009) and Business Source Premier (1995–2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. A total of 33 US studies met review criteria. Among the four highest‐quality studies, the 2008 per‐person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimates included use of national samples vs. more selected populations, age groups examined, inclusion of all medical costs vs. obesity‐related costs only, and body mass index cut‐offs for defining overweight and obesity. Depending on the source of total national healthcare expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs and use standard body mass index cut‐offs.     

The cost of pressure ulcers in the UK

OBJECTIVE: To estimate the annual cost of treating pressure ulcers in the UK. DESIGN: Costs were derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reflecting good clinical practice. SETTING: Health and social care system in the UK. SUBJECTS: Patients developing a pressure ulcer. METHODS: A bottom-up costing approach is used to estimate treatment cost per episode of care and per patient for ulcers of different grades and level of complications. Also, total treatment cost to the health and social care system in the UK. RESULTS: The cost of treating a pressure ulcer varies from pound 1,064 (Grade 1) to pound 10,551 (Grade 4). Costs increase with ulcer grade because the time to heal is longer and because the incidence of complications is higher in more severe cases. The total cost in the UK is pound 1.4- pound 2.1 billion annually (4% of total NHS expenditure). Most of this cost is nurse time. CONCLUSIONS: Pressure ulcers represent a very significant cost burden in the UK. Without concerted effort this cost is likely to increase in the future as the population ages. To the extent that pressure ulcers are avoidable, pressure damage may be indicative of clinical negligence and there is evidence that litigation could soon become a significant threat to healthcare providers in the UK, as it is in the USA.     

Investment case for the prevention and reduction of childhood and adolescent overweight and obesity in Mexico

Despite efforts to curb the rise in Mexico's child and adolescent overweight and obesity rates, prevalence in Mexico has grown by 120% since 1990 to 43.3% in 2022. This investment case identifies policies that will produce the largest returns for Mexico. The investment case model builds beyond a cost-of-illness analysis by predicting the health and societal economic impact of implementing child and adolescent overweight and obesity interventions in a cohort aged 0–19 from 2025 to 2090. The Markov model's impacts include healthcare expenditures, years of life lost, and reduced wages and productivity. We projected and compared costs in a status quo scenario to an intervention scenario to estimate cost savings and calculate return-on-investment (ROI). Total lifetime health and economic costs amount to USD 1.8 trillion—USD 30 billion on average per year. Implementing five interventions can reduce lifetime costs by approximately 7%. Each intervention has a low cost per disability-adjusted life year averted over 30-year, 50-year, and lifetime horizons. The findings demonstrate that a package of interventions mitigating child and adolescent overweight and obesity offers a strong ROI. The novel investment case methods should be applied to other countries, particularly low- and middle-income countries.     

Economic burden of post-acute myocardial infarction heart failure in the United Kingdom

Congestive heart failure (CHF) is a major cause of morbidity and mortality. This study was carried out to quantify the burden of CHF, subsequent to acute myocardial infarction (AMI), from the perspective of the UK National Health Service (NHS). A systematic literature review of publications since 1990 was carried out on the economic burden of heart failure. The economic burden of post-AMI heart failure in the UK for the year 2000 was estimated for two scenarios: (1) Base-case estimate (post-AMI heart failure accounts for 20% of heart failure cases): Direct healthcare costs of pound 125-181 million (approx. 0.4% of total NHS spend) and nursing home costs of pound 27 million; (2) Upper estimate (post-AMI heart failure accounts for 50% of the total): Direct healthcare costs of pound 313-453 million (approx 1.0% of total NHS spend) and nursing home costs of pound 68 million. In conclusion, post-AMI heart failure imposes a significant direct economic burden on the UK.     

The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992

Aims, design and setting. The economic costs of alcohol, tobacco and illicit drugs to Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines. Measurements. For causes of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs. The results are compared with other studies, and sensitivity analyses are conducted on alternative measures of alcohol consumption, alternative discount rates for productivity costs and the use of diagnostic-specific hospitalization costs. Findings. The misuse of alcohol, tobacco and illicit drugs cost more than $18.4 billion in Canada in 1992, representing $649 per capita or 2.7% of GDP. Alcohol accounts for approximately $7.52 billion in costs, including $4.14 billion for lost productivity, $1.36 billion for law enforcement and $1.30 billion in direct health care costs. Tobacco accounts for approximately $9.56 billion in costs, including $6.82 billion for lost productivity and $2.68 billion for direct health care costs. The economic costs of illicit drugs are estimated at $1.4 billion. Conclusions. Substance abuse exacts a considerable toll to Canadian society in terms of illness, injury, death and economic costs.     

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.     

Modelling the economic impact of managing a chronic anal fissure with a proprietary formulation of nitroglycerin (Rectogesic) compared to lateral internal sphincterotomy in the United Kingdom

BACKGROUND AND AIMS: This study estimated the economic impact of using a proprietary formulation of 0.2% nitroglycerin (GTN) ointment (Rectogesic) compared with lateral internal sphincterotomy in the treatment of a chronic anal fissure in the United Kingdom (UK), from the perspective of the National Health Service (NHS). PATIENTS AND METHODS: Clinical and surgical outcomes attributable to managing a chronic anal fissure were obtained from published literature, supplemented with information about resource utilisation derived from interviews with a panel of colorectal surgeons and general practitioners. Using this information, a decision tree modelling the management of a chronic anal fissure by a colorectal surgeon was constructed. Unit resource costs at 1999/2000 prices were applied to the resource utilisation estimates in the model to estimate the expected NHS cost of managing a chronic anal fissure. Consensus on the information contained within the model was reached at a meeting with an expert panel comprising five of the interviewees and one other colorectal surgeon. RESULTS: The expected NHS cost of a colorectal surgeon initially managing a chronic anal fissure with GTN was estimated to be pound616, compared to pound840 when a lateral internal sphincterotomy is the first-line treatment. Moreover, the expected probability of successful healing following initial treatment with either intervention is 99-100%, taking into account all subsequent treatments. CONCLUSION: The initial use of GTN compared to lateral internal sphincterotomy to treat a chronic anal fissure affords a potential cost reduction to the NHS of pound224 per patient without any loss in effectiveness. Hence, GTN is potentially a cost-effective first-line treatment strategy for the management of a chronic anal fissure.     

Obesity morbidity and health care costs in France: an analysis of the 1991-1992 Medical Care Household Survey

OBJECTIVE: To estimate the direct medical costs associated with obesity in France. DESIGN: Analysis of the French 1991-1992 National Household Survey database comprising a representative sample of 14, 670 individuals aged 18 y and over. A subgroup of subjects with a body mass index (BMI)>/=30 kg/m2 was compared with a control group of normal-weight individuals (BMI 18.5-25 kg/m2) matched on age, gender and education level. MEASUREMENTS: Self-reported weight and height used to calculate individual body mass index and health expenditures in a 3 month period, and morbidity as declared by respondents to the national household survey and verified on medical records. RESULTS: The direct cost attributable to obesity (BMI>/=30 kg/m2) was estimated to be in the range 4.2-8.7 billion French Francs (FF) in 1992 value, that is between 0.7 and 1.5% of total health expenditures. CONCLUSION: These results were of the same order of magnitude as similar estimates obtained by a top-down approach for the same year and setting. International Journal of Obesity (2000) 24, 151-155     

Carvedilol reduces the costs of medical care in severe heart failure: an economic analysis of the COPERNICUS study applied to the United Kingdom

BACKGROUND: The aim of this study was to determine the effects of carvedilol on the costs related to the treatment of severe chronic heart failure (CHF). METHODS: Costs for the treatment for heart failure within the National Health Service (NHS) in the United Kingdom (UK) were applied to resource utilisation data prospectively collected in all patients randomized into the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study. Unit-specific, per diem (hospital bed day) costs were used to calculate expenditures due to hospitalizations. We also included costs of carvedilol treatment, general practitioner surgery/office visits, hospital out-patient clinic visits and nursing home care based on estimates derived from validated patterns of clinical practice in the UK. RESULTS: The estimated cost of carvedilol therapy and related ambulatory care for the 1156 patients assigned to active treatment was pound530,771 ( pound44.89 per patient/month of follow-up). However, patients assigned to carvedilol were hospitalised less often and accumulated fewer and less expensive days of admission. Consequently, the total estimated cost of hospital care was pound3.49 million in the carvedilol group compared with pound4.24 million for the 1133 patients in the placebo arm. The cost of post-discharge care was also less in the carvedilol than in the placebo group ( pound479,200 vs. pound548,300). Overall, the cost per patient treated in the carvedilol group was pound3948 compared to pound4279 in the placebo group. This equated to a cost of pound385.98 vs. pound434.18, respectively, per patient/month of follow-up: an 11.1% reduction in health care costs in favour of carvedilol. CONCLUSIONS: These findings suggest that not only can carvedilol treatment increase survival and reduce hospital admissions in patients with severe CHF but that it can also cut costs in the process.     

Assessment of the economic burden of COPD in the U.S.: a review and synthesis of the literature

The costs of chronic obstructive pulmonary disease (COPD) pose a major economic burden to the United States. Studies evaluating COPD costs have generated widely variable estimates; we summarized and critically compared recent estimates of the annual national and per-patient costs of COPD in the U.S. Thirteen articles reporting comprehensive estimates of the direct costs of COPD (costs related to the provision of medical goods and services) were identified from searches of relevant primary literature published since 1995. Few papers reported indirect costs of COPD (lost work and productivity). The National Heart, Lung, and Blood Institute (NHLBI) provides the single current estimate of the total (direct plus indirect) annual cost of COPD to the U.S., $38.8 billion in 2005 dollars. More than half of this cost ($21.8 billion) was direct, aligning with the $20-26 billion range reported by two other recent analyses of large national datasets. For per-patient direct costs (in $US 2005), studies using recent data yield attributable cost estimates (costs deemed to be related to COPD) in the range of $2,700-$5,900 annually, and excess cost estimates (total costs incurred by COPD patients minus total costs incurred by non-COPD patients) in the range of $6,100-$6,600 annually. Studies of both national and per-patient costs that use data approximately 8-10 years old or older have produced estimates that tend to deviate from these ranges. Cost-of-illness studies using recent data underscore the substantial current cost burden of COPD in the U.S.     

Economic evaluation of the societal costs of hepatitis B in South Korea

BACKGROUND AND AIMS: Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health-care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997). METHODS: The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates. RESULTS: The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV-related diseases. The total cost (direct plus indirect) associated with HBV-related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis-related costs. In terms of disease-related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health-care expenditure for 1997. CONCLUSIONS: This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.     

Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analysis of the British NHS bridge to transplant (BTT) program

Background

A previous cost-effectiveness analysis showed that bridge to transplant (BTT) with early design left ventricular assist devices (LVADs) for advanced heart failure was more expensive than medical management while appearing less beneficial.Older LVADs were pulsatile, but current second and third generation LVADs are continuous flow pumps. This study aimed to estimate comparative cost-effectiveness of BTT with durable implantable continuous flow LVADs compared to medical management in the British NHS.

Methods and results

A semi-Markov multi-state economic model was built using NHS costs data and patient data in the British NHS Blood and Transplant Database (BTDB). Quality-adjusted life years (QALYs) and incremental costs per QALY were calculated for patients receiving LVADs compared to those receiving inotrope supported medical management. LVADs cost £80,569 ($127,887) at 2011 prices and delivered greater benefit than medical management. The estimated probabilistic incremental cost-effectiveness ratio (ICER) was £53,527 ($84,963)/QALY (95%CI: £31,802–£94,853; $50,479–$150,560) (over a lifetime horizon). Estimates were sensitive to choice of comparator population, relative likelihood of receiving a heart transplant, time to transplant, and LVAD costs. Reducing the device cost by 15% decreased the ICER to £50,106 ($79,533)/QALY.

Conclusions

Durable implantable continuous flow LVADs deliver greater benefits at higher costs than medical management in Britain. At the current UK threshold of £20,000 to £30,000/QALY LVADs are not cost effective but the ICER now begins to approach that of an intervention for end of life care recently recommended by the British NHS. Cost-effectiveness estimates are hampered by the lack of randomized trials.     

Costes sanitarios directos del asma de origen laboral en España: una estimación para el año 2008

Background

Occupational asthma is the most common work-related disease in industrialized countries. In 2008, only 556 cases of occupational asthma had been diagnosed in Spain, which is quite far from even the most conservative estimates. In this context, the aim of this paper is to estimate the number of asthma cases attributable to the work setting in Spain in 2008 as well as the related health care costs for the same year.

Methods

The number of cases of occupational asthma was calculated from estimates of attributable risk given by previous studies. The cost estimation focused on direct health-care costs and it was based both on data from the National Health System's (NHS) analytical accounting and from secondary sources.

Results

The number of prevalent cases of work-related asthma in Spain during 2008 ranges between 168,713 and 204,705 cases based on symptomatic diagnosis, entailing an associated cost from 318.1 to 355.8 million Euros. These figures fall to a range between 82,635 and 100,264 cases when bronchial hyperreactivity is included as a diagnostic criterion, at a cost of 155.8 to 174.3 million Euros. Slightly more than 18 million Euros represent the health-care costs of those cases requiring specialized care.

Conclusions

Estimations of occupational asthma are very relevant to adequately prevent this disease. The treatment of occupational asthma, which involves a significant cost, is being financed by the NHS, although it should be covered by Social Security.     

The cost of alcohol in California

Background: California is the largest alcohol market in the United States. In 2005 alone, Californians consumed almost 14 billion alcoholic drinks, which contributed to many severe and potentially fatal alcohol‐related illnesses and conditions. Alcohol use also causes violent and nonviolent crimes, as well as injuries and traffic collisions. While several studies have estimated the magnitude and cost of these problems nationally and others have analyzed underage drinking costs, no overall cost estimate at the state level currently exists for California. We present the first comprehensive estimate of the cost of alcohol consumption in California. Methods: For each category of alcohol‐related problems, we estimated fatal and nonfatal cases attributable to alcohol use. We multiplied alcohol‐attributable cases by estimated costs per case to obtain total costs for each problem. Our estimates are presented in 2 sections, the economic costs, estimated using a human capital approach, and quality‐of‐life costs estimated using a quality adjusted life year framework. Results: Alcohol consumption in California led to an estimated 9,439 deaths and 921,929 alcohol‐related problems, such as crime and injury in 2005. The economic cost of these problems is estimated at between $35.4 billion and $42.2 billion. Our main estimate is $38.5 billion, of which $5.4 billion was for medical and mental health spending, $25.3 billion in work losses, and $7.8 billion in criminal justice spending, property damage and public program costs. In addition, alcohol is responsible for severe reductions in individuals’ quality of life in California. We estimate that the disability caused by injury, the personal anguish of violent crime victims, and the life years lost to fatality are the largest costs imposed by alcohol. The total value for this reduced quality of life in California is between $30.3 billion and $60.0 billion. Our main estimate for quality‐of‐life costs is $48.8 billion. Conclusions: In light of the associated substantial illness, injuries, death, and high cost to society, alcohol consumption in California needs serious attention. In addition, the methods developed in this paper can be expanded to estimate the cost of alcohol in other states.     

Cost of illness of Alzheimer's disease: how useful are current estimates?

PURPOSE: The goal of this literature review was to determine the validity and policy relevance of recent estimates from many countries of Alzheimer's disease (AD) costs. DESIGN AND METHODS: We searched Medline and other databases for English-language peer-reviewed journals on total, direct, indirect, and per case cost of AD that used 1985-2000 data. We adjusted costs of U.S. studies for inflation. We adjusted non-U.S. studies by that country's medical cost inflation rate and purchasing power parity (PPP). RESULTS: Of 71 studies identified, 21 met all criteria for inclusion. Annual inflation adjusted U.S. total costs of AD varied from $5.6 billion to $88.3 billion. AD total per case (direct and indirect) costs varied from $1,500 to $91,000; indirect/family costs varied from $3,700 to $21,000. Among non-U.S. studies, AD annual adjusted per case costs varied from PPP $2,300 to PPP $30,000. Cost variation was due to diverse study methods, data sources, services included, and lack of clear differentiation between cost of AD and cost of caring for people with AD. IMPLICATIONS: The cost of AD is high, although reliable estimates are not available. Costs are likely to rise given expected demographic shifts in all countries. The widely variable cost estimates call into question the real costs of Alzheimer's disease and their applicability to policy initiatives.     

Costs of occupational COPD and asthma.

OBJECTIVE: To estimate the number of annual deaths, as well as the direct and indirect costs of occupational COPD and asthma, in the United States in 1996. DESIGN: Aggregation and analysis of national data sets collected by the National Center for Health Statistics, the Health Care Financing Administration, and other government bureaus and private firms. To assess mortality, we reviewed data from national surveys and applied a population attributable risk (PAR) of 15% for both asthma and COPD. We use a lower age limit of 35 years for occupational COPD and 20 years for occupational asthma. To calculate costs, we use the human capital method that decomposes costs into direct categories, such as medical expenses, as well as indirect categories, such as lost earnings and lost home production. We calculated proportionately adjusted costs for other plausible PARs. RESULTS: The 15% PARs result in costs of $5.0 billion for COPD and $1.6 billion for asthma. For COPD, 56% of costs were direct and 44% were indirect; for asthma, 74% were direct and 26% indirect. These estimates are conservative since we ignored costs associated with pain and suffering as well as the value of care rendered by family members. The proportionately adjusted costs for 10 to 20% PARs are $3.3 to $6.6 billion for COPD and $1.1 to $2.1 billion for asthma. CONCLUSIONS: The estimated $6.6 billion cost of occupational COPD and asthma in 1996 is likely to rise with the increasing prevalence of these diseases and warrants preventive intervention.     

Cost impact of COPD in Japan: Opportunities and challenges?

OBJECTIVE: The Global Initiative for Obstructive Lung Disease highlights the importance of COPD from public health, health policy and clinical perspectives. In countries such as the USA, the economic impact of COPD exceeds that of many chronic conditions. There is a paucity of data on the economic burden of COPD in Japan. METHODOLOGY: Based upon publicly available information, a prevalence-based approach was used to construct a deterministic model to estimate the total direct and indirect costs of care for COPD in Japan. Data sources included a spirometry-based epidemiological study, the peer-reviewed literature, and governmental and industrial surveys. The most current data that addressed direct and indirect costs of care were utilized. RESULTS: In Japan, the estimated total cost of COPD is 805.5 billion yen (US 6.8 billion dollars) per year; 645.1 billion yen (US 5.5 billion dollars) in direct costs and 160.4 billion yen (US 1.4 billion dollars) in indirect costs. In direct costs, inpatient care accounted for 244.1 billion yen (US 2.1 billion dollars), outpatient care 299.3 billion yen (US 2.5 billion dollars), and home oxygen therapy 101.7 billion yen (US 0.9 billion dollars). The average annual total cost per patient for moderate/severe COPD is estimated to be 435,876 yen (US 3694 dollars); 349,080 yen (US 2958 dollars) per COPD patient in direct costs and 86,797 yen (US 795 dollars) in indirect costs. CONCLUSION: COPD imposes a high economic burden on the Japanese healthcare system. Health policy makers should direct urgent attention to increasing prevention, early diagnosis, and appropriate treatment of COPD.