Abstract
Objectives:
To investigate the association of the new GOLD with costs, disease-specific and generic health-related quality of life (HR-QoL) and compare this with the old GOLD.
Methods:
We selected COPD patients from electronic medical records of the general practices (ER-GP). The patients were interviewed by a research nurse and filled in a questionnaire. Lung function tests and medication prescription was obtained from the ER-GP. Generalized linear mixed models were created with costs (medication, primary care, healthcare, societal), disease specific (CCQ and SGRQ) and generic (SF-36 and EQ-5D) HR-QoL as independent variables. Either the new or the old GOLD stages were included in the model, as well as several covariates (age, gender, living situation, co-morbidity, self-efficacy, smoking, education, employment).
Results:
611 patients from 28 clusters of general practice teams were included: 333 GOLD-A, 110 GOLD-B, 80 GOLD-C and 88 GOLD-D. The new GOLD classification was stronger related to costs, disease specific and generic HR-QoL than the old classification (Aikaike information criterion was lower and proportion of explained variance higher). Mean CCQ score worsens significantly with 1.04 (GOLD-B), 0.4 (GOLD-C) and 1.21 (GOLD-D) compared to GOLD-A. Healthcare costs per patient were significantly higher in GOLD-B (72%), GOLD-C (74%) and GOLD-D (131%) as compared with GOLD-A patients.
Conclusion:
The new GOLD strategy showed a better association with costs, disease-specific and generic HR-QoL than the old strategy. In this primary care population GOLD-C patients had a better HR-QoL than GOLD-B patients, whereas costs did not differ.
- © 2013 ERS