Expert Review of Pharmacoeconomics & Outcomes Research

ISSN: 1473-7167 (Print) 1744-8379 (Online) Journal homepage: http://www.tandfonline.com/loi/ierp20

Burden of smoking on quality of life in patients with chronic obstructive pulmonary disease Aaron Galaznik, Jonathan Chapnick, Jeffrey Vietri, Shivani Tripathi, Kelly H Zou & Geoffrey Makinson To cite this article: Aaron Galaznik, Jonathan Chapnick, Jeffrey Vietri, Shivani Tripathi, Kelly H Zou & Geoffrey Makinson (2013) Burden of smoking on quality of life in patients with chronic obstructive pulmonary disease, Expert Review of Pharmacoeconomics & Outcomes Research, 13:6, 853-860 To link to this article: http://dx.doi.org/10.1586/14737167.2013.842128

Published online: 09 Jan 2014.

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Burden of smoking on quality of life in patients with chronic obstructive pulmonary disease Expert Rev. Pharmacoecon. Outcomes Res. 13(6), 853–860 (2013)

Aaron Galaznik*1, Jonathan Chapnick2, Jeffrey Vietri2, Shivani Tripathi1, Kelly H Zou1 and Geoffrey Makinson1 1 Pfizer Inc., 235 East 42nd Street, New York, NY 10017, USA 2 Kantar Health, 1 Independence Way, Suite 220, Princeton, NJ 08540, USA *Author for correspondence: Tel.: +1 212 733 4807 Fax: +1 646 441 4156 [email protected]

The objective of this study was to assess the impact of smoking on health-related quality of life, Work Productivity and Activity Impairment (WPAI) in chronic obstructive pulmonary disease (COPD) patients. Respondents of the 2009/2010 US National Health and Wellness Survey (NHWS), aged ‡40 years, with COPD, chronic bronchitis or emphysema, were included in the study. Current and former (had not smoked for ‡11 years) smokers were compared. Physical component summary (PCS) and mental component summary (MCS) scores from the Short Form-12 version 2 (SF-12v2), health utilities (SF-6D) and WPAI were evaluated. Differences between current (n = 1685) and former (n = 1932) smokers were revealed: MCS (44.80, 46.73; p < 0.01); PCS (35.12, 35.79; p < 0.1); SF-6D (0.63, 0.65; p < 0.05). WPAI: presenteeism (23%, 18%; p < 0.05); work impairment (25%, 21%; p < 0.05); activity impairment (52%, 49%; p < 0.01). In conclusion, COPD patients who smoke have poorer health-related quality of life, impaired productivity and higher healthcare costs than former smokers. KEYWORDS: activity impairment • COPD • productivity • quality of life • smoking • work productivity

Smoking is associated with both reduced health-related quality of life (HRQoL) [1] and greater lost productivity relative to formerand non-smokers [2]. Chronic obstructive pulmonary disease (COPD) is also recognized as having a considerable impact on HRQoL, work productivity and healthcare resource use, with greater burden in more severe forms of the disease [3]. Both cigarette smoking and COPD diagnosis are associated with poorer health outcomes than healthy individuals who do not smoke. Smoking cessation is one of the interventions for COPD for which there is evidence to support an improvement in lung function (forced expiratory volume in 1 sec/forced expiratory volume; FEV1/ FEV) and a reduction in mortality [4]. This study was conducted to better understand the impact of continued smoking among patients with COPD, including those diagnosed with emphysema and chronic bronchitis, as well as to further quantify the potential benefits for smokers with COPD who quit smoking. The health outcomes of patients with COPD who smoke were compared with those who were not current smokers. www.expert-reviews.com

10.1586/14737167.2013.842128

Outcomes included HRQoL and Work Productivity and Activity Impairment (WPAI). Materials & methods Sample

This study included data from the 2009 and 2010 National Health and Wellness Survey (NHWS; N = 75,000 each year). The NHWS is a self-administered, internet-based questionnaire from a sample of adults (aged ‡18 years) in the USA. A random sample (stratified by gender and age) was implemented to ensure that the demographic composition of sample was representative of the corresponding adult population. Comparisons between the NHWS and other established sources (US Census, National Health Interview Survey, National Health and Nutrition Examination Survey, etc.) have been made elsewhere [5]. The protocol and questionnaire for the NHWS were reviewed and approved by an independent IRB (Essex Institutional Review Board, New Jersey), and all respondents gave informed consent to participate.

 2013 Informa UK Ltd

ISSN 1473-7167

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Galaznik, Chapnick, Vietri, Tripath, Zou & Makinson

Table 1. Study groups. Current smokers (n = 1685)

Quit 0–5 years (n = 923)

Quit 6–10 years (n = 649)

Quit ‡11 years (n = 1932)

Aged ‡40 years

Aged ‡40 years

Aged ‡40 years

Aged ‡40 years

Diagnosed with COPD

Diagnosed with COPD

Diagnosed with COPD

Diagnosed with COPD

Reported currently smoking cigarettes

Reported not currently smoking

Reported not currently smoking

Reported not currently smoking

Not currently attempting to quit smoking

Reported quitting smoking 0–5 years ago

Reported quitting smoking 6–10 years ago

Reported quitting smoking ‡11 years ago

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COPD: Chronic obstructive pulmonary disease.

Covariates for the multivariable analyses included age, sex, race, type of health insurance, marital status, household income, BMI, alcohol use, exercise and diagnosis of asthma. Respondents aged ‡40 years at the time of the survey who reported a physician diagnosis of COPD, chronic bronchitis or emphysema were included in the analyses. Because of the self-report nature of the survey, spirometry results were not available and diagnoses could not be confirmed. For patients who completed the survey in both years, data from 2010 were used. Additional inclusion criteria included having a history of cigarette smoking. Patients who were attempting to quit smoking at the time of survey were excluded. The impact of smoking on outcomes in COPD was investigated by comparing HRQoL, WPAI and estimated indirect health costs among COPD patients who were current smokers at the time of the survey with that of COPD patients who had quit smoking. The group definitions and sample count are detailed in (TABLE 1). Measures: independent variables

The independent variable for this project was time since quitting cigarette smoking (TABLE 1). Patient status was classified as follows: Smoking group

Had reported a physician diagnosis of COPD, emphysema, and/or chronic bronchitis, were aged ‡40 years at the time of the survey, and had reported that they currently smoked cigarettes, and were not attempting to quit.

the survey, and had reported that they had quit smoking ‡11 years prior to completing the survey. Demographics

Demographic variables included age, gender, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic or other), marital status (married/living with partner or unmarried), education (no college degree vs education beyond college graduation), household income (up to US$24,999, US$25,000– 49,999, US$50,000–74,999, US$75,000 and above or declined to answer), employment type (full-time, part-time or selfemployed) and health insurance (yes or no). Health history

The health history variables examined included exercise, alcohol use, BMI and adjusted Charlson Comorbidity Index [6]. COPDspecific variables included the number of years diagnosed, selfreported COPD severity, frequency of COPD symptoms, causes of COPD episodes and use of a prescription medication. Dependent variables: outcomes Work productivity & indirect costs

Had reported a physician diagnosis of COPD, emphysema and/or chronic bronchitis were aged ‡40 years at the time of the survey, and had reported that they had quit smoking between 6–10 years prior to completing the survey.

Work productivity was assessed using the WPAI questionnaire, described elsewhere [7]. Four subscales (absenteeism, presenteeism, overall work impairment and activity impairment) were generated in the form of percentages (0–100%; higher values indicating greater impairment). Differences between the groups were compared on these four subscales and the number of hours of work missed due to absenteeism and presenteeism. Analyses incorporating absenteeism, presenteeism and overall work impairment included the employed subsample only. Analyses of activity impairment included both employed and unemployed respondents. Indirect costs were calculated using the US Department of Labor’s 2009 Bureau of Labor Statistics average wages, adjusted according to gender and age. The adjusted wages were multiplied by productivity impairment and then annualized to provide a figure for projected annual costs associated with loss in productivity.

Quit ‡11 years ago

Health-related quality of life.

Had reported a physician diagnosis of COPD, emphysema and/or chronic bronchitis were aged ‡40 years at the time of

Health-related quality of life (HrQol) was assessed using physical component summary (PCS) and mental component summary

Quit 0–5 years ago

Had reported a physician diagnosis of COPD, emphysema and/or chronic bronchitis were aged ‡40 years at the time of the survey, and had reported that they had quit smoking within 5 years prior to completing the survey. Quit 6–10 years ago

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Expert Rev. Pharmacoecon. Outcomes Res. 13(6), (2013)

Burden of smoking on quality of life in patients with COPD

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Table 2. Demographic characteristics of chronic obstructive pulmonary disease patients by smoking status. Current smokers (n = 1685)

Quit 0–5 years (n = 923)

Quit 6–10 years (n = 649)

Quit ‡11 years (n = 1932)

Sex (n; %) Male