Impact of smoking on the treatment cycle and health economics of acute exacerbations of chronic obstructive pulmonary disease.

INTRODUCTION

Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase disease progression and mortality. Smoking influences treatment and health economics. This study examines how smoking status affects medical costs, hospital stays, and outcomes in acute COPD exacerbations.

METHODS

We included 658 patients with acute COPD exacerbations, excluding those with asthma, allergic diseases, bronchiectasis, or tuberculosis. Participants were divided into never smokers (n=218) and smokers (n=440). Smokers were further classified as early smokers (age ≤24 years, n=70) or late smokers (age >24 years, n=370), and as current (n=164) or former smokers (n=276). We used Mann-Whitney U tests, chi-squared tests, and univariate logistic regression (p<0.05).

RESULTS

Median hospital stay was 11 days (IQR: 8-16) for smokers versus 10 days (IQR: 7-15) for never smokers (p=0.179). Median daily cost was 1280.63 versus 1182.01 RMB (1000 Chinese Renminbi about US$151.4, mean exchange rate 2018) (p=0.217). However, total treatment costs were higher for smokers (median=13477.81 [IQR: 9096.81-22651.91] vs 12296.95 RMB [7954.42-20392.61]; Hodges-Lehmann difference: 1068.87 RMB, p=0.045). Medicare (government health insurance program in China) payments were higher (12389.82 [7528.24-20366.10] vs 10216.77 RMB [4691.43-17742.65]; difference: 2349.09 RMB, p<0.001), while out-of-pocket payments were lower for smokers (1005.00 [100.00-2500.00] vs 1527.03 RMB [960.00-4686.97]; difference: -600 RMB, p<0.001). Early smokers had higher costs, longer stays (difference: 1.0 day, p=0.019), higher daily costs (difference: 173.2 RMB, p=0.001), and greater out-of-pocket payments (difference: 328.5 RMB, p=0.008) than late smokers. Current smokers had higher Medicare and total expenditures than former smokers (p=0.011 and p=0.010, respectively).

CONCLUSIONS

Smoking, especially early smoking, significantly increases the economic burden of acute COPD exacerbations without affecting hospital stay duration.