https://doi.org/10.4081/monaldi.2024.2745
Economic burden of chronic obstructive pulmonary disease in Morocco: a cost of illness study
Submitted: August 10, 2023
Accepted: December 29, 2023
Published: January 15, 2024
Accepted: December 29, 2023
Abstract Views: 482
PDF_EARLY VIEW: 256
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Chronic obstructive pulmonary disease (COPD) carries an important economic burden worldwide. However, the cost of this disease in Morocco is not well explored. This study aimed to estimate the economic cost associated with COPD in Morocco and identify its determinants. A cost of illness, prevalence-based study using a bottom-up approach method, including COPD patients, was carried out in 2021-2022. The cost was estimated from a societal perspective, and the time horizon was 1 year. Data collection was performed using a questionnaire including socio-demographic, clinical data, and utilization of health care resources in 2019: hospitalization, medical tests, medications, and medical visits. Direct health cost (DHC) was estimated by multiplying the use of health services by the official prices (unit costs) published by the National Agency for Health Insurance. The indirect cost (IC) represented by labor productivity losses was calculated using the human capital method. Costs were compared according to different socio-demographic and clinical factors. We included 159 patients; 82.4% were men, 80.4% were current or former smokers, and 78.7% were categorized as “high-risk” groups (grades C–D). The DHC was estimated at $1816.6 per patient per year. Pharmaceutical and hospitalization costs represented the highest part of the total DHC (42.5% and 22.1%, respectively). The IC was estimated at $709.5±1081.3 per patient per year. DHC increased with increasing disease severity and with the number of severe exacerbations (p<0.001). Current and former smokers were more costly to the healthcare system than nonsmokers (p=0.029). IC also increased with the number of severe exacerbations (p=0.003). In this study, we showed that COPD in Morocco generates important costs for the health system, mainly related to smoking and the severity of the disease. It is therefore important to strengthen tobacco control measures in our country.
Safiri S, Carson-Chahhoud K, Noori M, et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ 2022;378:e069679.
DOI: https://doi.org/10.1136/bmj-2021-069679
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204-22.
DOI: https://doi.org/10.1016/S0140-6736(20)30925-9
Foo J, Landis SH, Maskell J, et al. Continuing to confront COPD international patient survey: economic impact of COPD in 12 countries. PLoS One 2016;11:e0152618.
DOI: https://doi.org/10.1371/journal.pone.0152618
CDC. COPD costs. 2019. Available from: https://www.cdc.gov/copd/infographics/copd-costs.html. Accessed on: 16/07/2022.
Iheanacho I, Zhang S, King D, et al. Economic burden of chronic obstructive pulmonary disease (COPD): a systematic literature review. Int J Chron Obstruct Pulmon Dis 2020;15:439-60.
DOI: https://doi.org/10.2147/COPD.S234942
Fishman PA, Khan ZM, Thompson EE, Curry SJ. Health care costs among smokers, former smokers, and never smokers in an HMO. Health Serv Res 2003;38:733-49.
DOI: https://doi.org/10.1111/1475-6773.00142
Robbins AS, Fonseca VP, Chao SY, et al. Short term effects of cigarette smoking on hospitalisation and associated lost workdays in a young healthy population. Tob Control 2000;9:389-96.
DOI: https://doi.org/10.1136/tc.9.4.389
Wacker M, Holle R, Heinrich J, et al. The association of smoking status with healthcare utilisation, productivity loss and resulting costs: results from the population-based KORA F4 study. BMC Health Serv Res 2013;13:278.
DOI: https://doi.org/10.1186/1472-6963-13-278
Halpin DMG, Celli BR, Criner GJ, et al. The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries. Int J Tuberc Lung Dis 2019;23:1131-41.
DOI: https://doi.org/10.5588/ijtld.19.0397
Rossaki FM, Hurst JR, van Gemert F, et al. Strategies for the prevention, diagnosis and treatment of COPD in low- and middle- income countries: the importance of primary care. Expert Rev Respir Med 2021;15:1563-77.
DOI: https://doi.org/10.1080/17476348.2021.1985762
WHO. Chronic obstructive pulmonary disease (COPD). 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd). Accessed on: 23/05/2022.
Tageldin MA, Nafti S, Khan JA, et al. Distribution of COPD-related symptoms in the Middle East and North Africa: results of the BREATHE study. Respir Med 2012;106:S25-32.
DOI: https://doi.org/10.1016/S0954-6111(12)70012-4
Rhazi KE, Nejjari C, BenJelloun MC, et al. Prevalence of chronic obstructive pulmonary disease in Fez, Morocco: results from the BOLD study. Int J Tuberc Lung Dis 2016;20:136-41.
DOI: https://doi.org/10.5588/ijtld.15.0029
Ministry of Health. Rapport de l’enquete nationale sur les facteurs de risque des maladies non transmissibles 2017-2018. Available from: https://www.sante.gov.ma/Documents/2019/05/Rapport%20de%20l%20enqu%C3%AAte%20Stepwise.pdf.
Brakema EA, Tabyshova A, van der Kleij RMJJ, et al. The socioeconomic burden of chronic lung disease in low-resource settings across the globe – an observational FRESH AIR study. Respir Res 2019;20:291.
DOI: https://doi.org/10.1186/s12931-019-1255-z
Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol 2014;20:327-37.
DOI: https://doi.org/10.3350/cmh.2014.20.4.327
Global Initiative for Chronic Obstructive Lung Disease. Global strategy of the diagnosis, the magement and prevention of obtructive pulmonary disease. 2018 report . Available from: https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf
Byford S, Torgerson DJ, Raftery J. Cost of illness studies. BMJ 2000;320:1335.
DOI: https://doi.org/10.1136/bmj.320.7245.1335
ANAM. Tarification nationale de référence . Available from: https://anam.ma/anam/regulation/tarification-nationale-de-reference/. [Material in French].
ANAM. Tarifs nationaux de référence pour le remboursement ou la prise en charge des appareillages et dispositifs médicaux. 2008. Available from: https://www.cnss.ma/sites/default/files/Remboursement%20et%20prise%20en%20charge%20et%20appareillage%20des%20dispositifs%20m%C3%A9dicaux.pdf
Ministry of Health. Assurance maladie obligatoire, guide des médicaments remboursables. Available from: https://www.sante.gov.ma/Documents/Activite/guide%20mdcts%20remboursables.pdf.
Invensting.com. USD MAD données historiques. Available from: https://fr.investing.com/currencies/usd-mad-historical-data. Accessed on: 18/07/2022.
WHO. Economics of tobacco toolkit: assessment of the economic costs of smoking. Available from: https://iris.who.int/bitstream/handle/10665/44596/9789241501576_eng.pdf?sequence=1. Accessed on: 23/11/2023.
Koopmanschap MA, Rutten FF. A practical guide for calculating indirect costs of disease. Pharmacoeconomics 1996;10:460-6.
DOI: https://doi.org/10.2165/00019053-199610050-00003
Rehman AU, Hassali MAA, Muhammad SA, et al. The economic burden of chronic obstructive pulmonary disease (COPD) in the USA, Europe, and Asia: results from a systematic review of the literature. Expert Rev Pharmacoecon Outcomes Res 2020;20:661-72.
DOI: https://doi.org/10.1080/14737167.2020.1678385
Merino M, Villoro R, Hidalgo-Vega Á, Carmona C. Social economic costs of COPD in Extremadura (Spain): an observational study. Int J Chron Obstruct Pulmon Dis 2018;13:2501-14.
DOI: https://doi.org/10.2147/COPD.S167357
Rehman AU, Hassali MAA, Muhammad SA, et al. The economic burden of chronic obstructive pulmonary disease (COPD) in Europe: results from a systematic review of the literature. Eur J Health Econ 2020;21:181-94.
DOI: https://doi.org/10.1007/s10198-019-01119-1
Gutiérrez Villegas C, Paz-Zulueta M, Herrero-Montes M, et al. Cost analysis of chronic obstructive pulmonary disease (COPD): a systematic review. Health Econ Rev 2021;11:31.
DOI: https://doi.org/10.1186/s13561-021-00329-9
Idrees M, Koniski ML, Taright S, et al. Management of chronic obstructive pulmonary disease in the Middle East and North Africa: results of the BREATHE study. Respir Med 2012;106:S33-44.
DOI: https://doi.org/10.1016/S0954-6111(12)70013-6
Larsson K, Janson C, Lisspers K, et al. The impact of exacerbation frequency on clinical and economic outcomes in Swedish COPD patients: the ARCTIC study. Int J Chron Obstruct Pulmon Dis 2021;16:701-13.
DOI: https://doi.org/10.2147/COPD.S297943
Benouhoud N, Trombati N, Afif H, Aichane A, Bouayad Z. Evaluation de la prise en charge des broncho-pneumopathies chroniques obstructives auprès des médecins généralistes marocains du secteur libéral. Revue de Pneumologie Clinique 2007;63:40-4. [Article in French].
DOI: https://doi.org/10.1016/S0761-8417(07)90088-7
Ye BZ, Wang XY, Wang YF, et al. Impact of tobacco smoking on health care utilization and medical costs in chronic obstructive pulmonary disease, coronary heart disease and diabetes. Curr Med Sci 2022;42:304-16.
DOI: https://doi.org/10.1007/s11596-022-2581-9
Örnek T, Tor M, Altın R, et al. Clinical factors affecting the direct cost of patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Int J Med Sci 2012;9:285-90.
DOI: https://doi.org/10.7150/ijms.4039
Pezzuto A, Ricci A, D’Ascanio M, et al. Short-term benefits of smoking cessation improve respiratory function and metabolism in smokers. Int J Chron Obstruct Pulmon Dis 2023;18:2861-5.
DOI: https://doi.org/10.2147/COPD.S423148
Ethics approval
The study was approved by the Ethics Committee of the Ibn Sina University Hospital in October 2021. Reference: 57/21.Supporting Agencies
This work was supporting by World health Organization consultant contract 202755314.How to Cite
Benmaamar, Soumaya, Btissame Es-sabbahi, Mohammed Taghyioullah Haiba, Mohamed Omari, Ibtissam El Harch, Mohammed Youbi, Latifa Belakhhel, Loubna Abousselham, Hafid Hachri, Imane El Menchawyi, Samira EL Fakir, Mohammed Chakib Benjelloun, and Nabil Tachfouti. 2024. “Economic Burden of Chronic Obstructive Pulmonary Disease in Morocco: A Cost of Illness Study”. Monaldi Archives for Chest Disease, January. https://doi.org/10.4081/monaldi.2024.2745.
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.