The economic impact of acute exacerbations of chronic bronchitis in the United States and Canada: a literature review.

BACKGROUND: Acute exacerbations of chronic bronchitis (AECB) are recurrent and potentially severe medical events for the 13 million people in the United States who have chronic bronchitis. Medical resource use associated with AECB can have a substantial economic impact on the patients, health care system, and society overall. OBJECTIVE: To evaluate literature on the economic impact of AECB in terms of cost of illness, cost of treatments, and cost-effectiveness. METHODS: A MEDLINE literature search was conducted for studies of chronic bronchitis and costs. Reference lists of identified articles were also retrieved for review. RESULTS: Eight published studies were identified: 2 cost-of-illness studies, 1 comparative cost study, and 5 cost-effectiveness studies. Important drivers of costs associated with AECB include hospitalization and choice of antibiotics. In mild to moderate AECB, patient adherence with therapy is essential to consider when selecting treatment. The antibiotic with the lowest acquisition cost has not been shown to be the most cost effective, as adherence and clinical outcomes, particularly rehospitalization rates, differ. CONCLUSION: Further research in these areas is needed to guide clinical decision making and the conduct of disease management programs.