Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study

Aizhamal Tabyshova; Bermet Estebesova; Alina Beishenbekova; Talant Sooronbaev; Evelyn A Brakema; Niels H Chavannes; Maarten J Postma; Job F M van Boven

doi:10.2147/COPD.S322778

Clinical Characteristics, Treatment Patterns and Economic Burden of COPD in Kyrgyzstan: A FRESH AIR Study

Int J Chron Obstruct Pulmon Dis. 2021 Oct 11:16:2833-2843. doi: 10.2147/COPD.S322778. eCollection 2021.

Authors

Aizhamal Tabyshova^{1

2}, Bermet Estebesova^{3

4}, Alina Beishenbekova⁵, Talant Sooronbaev¹, Evelyn A Brakema⁶, Niels H Chavannes⁶, Maarten J Postma^{2

7

8

9}, Job F M van Boven¹⁰

Affiliations

¹ Pulmonology Department, National Center of Cardiology and Internal Medicine Named After M.M. Mirrakhimov, Bishkek, Kyrgyzstan.
² Department of Health Sciences, Unit of Global Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Kyrgyz-Russian Slavic University (KRSU), Bishkek, Kyrgyzstan.
⁴ Primary Care Center of the Ministry of Internal Affairs, Bishkek, Kyrgyzstan.
⁵ International Medical University, Bishkek, Kyrgyzstan.
⁶ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands.
⁸ Department of Pharmacology & Therapy, Airlangga University, Surabaya, Indonesia.
⁹ Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
¹⁰ University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.

Abstract

Background: COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings.

Aim: We aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan.

Methods: A representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score ≥4) and cost were assessed using logistic regression analyses.

Results: A total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV₁ was 46% (SD: 12.8), 71.9% had COPD GOLD III-IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients' annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost.

Conclusion: The clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or ex-smokers and biomass exposure was high.

Keywords: COPD; Kyrgyzstan; clinical characteristics; economics; healthcare utilization.

MeSH terms

Cost of Illness*
Female
Humans
Kyrgyzstan / epidemiology
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / therapy
Respiratory Function Tests
Spirometry

Grants and funding

This study was funded by the EU Research and Innovation program Horizon 2020 (Health, Medical research and the challenge of ageing) under grant agreement no. 680997.