الفهرس 
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Abstract
The aim of this study was to evaluate the direct cost (for diagnosis and treatment) of COPD patient with acute exacerbation admitted to El-Fayoum Chest Hospital from the 1st July 2010 to 1st December 2010 and to assess risk factors influencing it.
Subjects and methods:
This study was conducted on all patients who were admitted in our hospital at that period. Eight hundred and fifty-two patients were included in the study and they were divided into COPD group which included 461 patients admitted with AECOPD and non-COPD group which divided into Tuberculosis (T.B.) group including 42 patients, pulmonary tuberculosis (38 patients) and tuberculous pleural effusion (4 patients). Non-T.B. group including 349 patients who were admitted by any other respiratory disease other than T.B., i.e. (acute exacerbation of asthma, acute exacerbation of diffuse parynchemal lung disease, respiratory infections; pneumonia, lung abscess, and pleural effusion other than tuberculous pleural effusion).
The selection of the AE-COPD cases was based on the GOLD, 2009 which define an exacerbation as an event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and /or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD (GOLD, 2009).
All patients were subjected to history taking, careful general and local examination, chest X ray, routine investigations, BODE index before discharge from the hospital.
Results:
• In the current study, we found that the number of the patients hospitalized for AECOPD were 54% of all patients admitted to the hospital in same period.
• Older age and male sex had more hospitalizations due to AECOPD.
• It was surprising that only 17% of the patients with AECOPD were current smokers while 40.6% of patients were non-smoker, 42.3% were ex-smoker.
• There was a strong association of cardiovascular comorbidity (HTN, IHD, Cor-pulmonale) and hospitalizations attributed to COPD exacerbations.
• Number of exacerbations in the previous year is an important risk factor for exacerbations necessitating hospitalization.
• AECOPD cost represented 67% of the total respiratory-related hospitalization cost. The total cost of an acute exacerbation was (LE 429.59±148.94) per patient which represented 5.2 folds increase than the cost of patient admitted with pulmonary tuberculosis (LE 82.05±24.44) and represented 2.1 folds increase than the cost of the patient admitted with diagnosis other than tuberculosis (LE 203.41±102.67).
• The main driver of cost of AECOPD was the drug cost which represented by 69.8% of total cost (antibiotics were the more costly medications), followed by the investigation cost 19.82%, and the oxygen cost 9.76%.
• When we analyzed the factors associated with the high costs of AECOPD, we found that, advancing age was a significant factor leading to higher expected total hospital costs. The age group of ˃75 years were the most costly age group. Also cardiovascular comorbidities (HTN, IHD, Cor-pulmonale) were associated with increasing the cost and hospital stay. Frequency of exacerbations in the previous year was an important risk factor for increasing the cost and prolonging the hospitalization period of the current exacerbation.
• Readmission to hospital was common among COPD patients discharged from hospital after an acute exacerbation. Of 461 patients admitted with AECOPD in our study, 74 patients (16%) were re-admitted with AECOPD during period of the study. Fifty-six patients with one readmission (12.1%), 14 patients with two readmissions (3%), 4 patients with three readmissions (0.86%).
• A strong relation was found between the BODE index score and the cost of the hospitalization and length of stay. Patients with a high BODE index score were frequent exacerbators (having more than 2 exacerbations in the previous year), more costly current exacerbation, more prolonged hospitalization. the BODE index could be a useful tool to evaluate the severity of an exacerbation of COPD.
• from this study, we conclude that acute exacerbations of COPD are a key driver of hospital costs. Drug cost is the major determinant of the cost. Interventions aiming at preventing exacerbations and delaying the progression of disease may be cost- effective.