Resource Use and Health Care Costs of COPD Patients at the End of Life: A Systematic Review.

Context: Patients with chronic obstructive pulmonary disease (COPD) in their final months of life potentially place a high burden on health care systems. Concrete knowledge about resources used and costs incurred by those patients at the end of life is crucial for policymakers.

Objectives: The aim of this systematic review was to describe the resources used and costs incurred by patients with COPD at the end of life.

Methods: We performed a comprehensive literature search in MEDLINE, Web of Science, and EconLit. We screened 886 abstracts and subsequently reviewed 80 full-text articles. Inclusion criteria were at least one type of resource use and/or cost outcome reported in adults diagnosed with COPD during an end-of-life period. Subsequently, we performed quality appraisal consistent with the ISPOR checklist for retrospective database studies and accomplished comprehensive data extraction.

Results: Ten articles fulfilled the inclusion criteria. Three, five, and two studies described European, North American, and Asian health care settings, respectively. All studies had a retrospective design and were published between 2006 and 2015. We observed a very variable resource use, an increased number of hospitalizations, intensive care unit stays, primary care consultations and medication prescriptions, as well as a lack of utilization of formal palliative care services in end-of-life COPD patients. Specific cost items were not well described.

Conclusion: The high use of health care resources in COPD patients in the final months of life suggests a focus on prolonging life and a tendency toward aggressive care. Limiting potentially inappropriate care and improving the quality of end-of-life care in advanced COPD are, therefore, important public health challenges.