An extensive MEDLINE search revealed a paucity of studies assessing economic outcomes associated with managing emphysema. Consequently, we estimated the annual levels of National Health Service (NHS) resource use and corresponding costs (at 1995/96 prices), by performing a subgroup analysis of a prevalence-based burden of illness analysis that measured the annual NHS cost of managing all community-acquired lower respiratory tract infections (LRTIs) during 1992/93 in the UK. As there have been few therapeutic innovations in the management of emphysema over the last 5 years, we consider that this sub-analysis offers a robust indication of the order of magnitude of resource use and corresponding costs. To the best of our knowledge, this is the first estimate assessing the costs of emphysema. The subanalysis estimated that the NHS spends Lstg 19 million at 1995/96 prices, treating 134 000 episodes of emphysema. Inpatient stay for emphysema costs Lstg 7.7 million annually and forms the main cost driver. General practitioner (GP) consultations cost Lstg 4.94 million and outpatient clinic visits Lstg 1.12 million. Drugs prescribed by GPs cost an estimated Lstg 0.87 million with another Lstg 0.42 million attributable to hospital prescribing. GP-initiated and inpatient-based diagnostic tests accounted for Lstg 2.63 million and Lstg 0.51 million, respectively. Community nursing visits cost Lstg 0.15 million and NHS Transport Lstg 0.46 million. Approximately half of this expenditure is incurred in hospitals, yet only 3% of all episodes of emphysema are treated in hospital. The cost of a hospital admission to manage emphysema was estimated at Lstg 2000. In contrast, the average community cost was Lstg 71 per episode. Therefore, reducing either the number of hospital admissions or the length of hospital stay will reduce the total direct healthcare costs. The relatively small expenditure on emphysema probably reflects both the low prevalence of the disease and the dominance of low-cost modes of treatment. However, several specific treatments are under development, which may increase costs. These new treatments will not only be required to demonstrate clinical effectiveness, but also cost effectiveness. The present analysis should provide a baseline for the annual levels of resource use and corresponding costs in emphysema management that can be used in future economic evaluations. Clearly, emphysema is an area that needs further research. Without this research, there will be a danger that new treatments will be introduced without supporting economic arguments that will enable policy formers to make informed resource allocation decisions. Such decisions will be affected by the demographic shifts currently taking place, since the burden of emphysema is borne by the elderly. Additionally, the analysis raises the prospect that the application of disease management systems that provides for more community-based resources could reduce the requirement for hospitalisation, thereby reducing the total direct healthcare costs.
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