(193) Systematic Literature Review on The Economic Burden of Chronic Cough

Publication Number: 867

Background: Chronic cough (CC) is defined as a cough that lasts 8 or more weeks. Healthcare resource utilization (HCRU) and cost associated with CC are unknown.

Objectives: To identify and describe published evidence on HCRU and cost associated with CC.

Methods: A systematic literature review was initiated in February 2021. The target population was adults with CC defined using CHEST guidelines. No intervention or comparator search terms were applied to capture all relevant studies examining HCRU and cost associated with CC. Outcomes of interest were total healthcare costs, direct costs, indirect costs, out-of-pocket costs, and resource utilization. Relevant studies meeting predefined selection criteria were identified through systematic searches of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (Embase), American Economic Association EconLit, and EBM Reviews. Hand searches of five relevant conference proceedings from the past two years and health technology assessment body websites were carried out to supplement the evidence base. The process of study screening, study selection, and data extraction was conducted by two independent reviewers and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Drummond Checklist was used to assess study quality. Studies were limited to English language only without time or geographical restrictions.

Results: A total of 1,742 citations were identified through searches of the databases. Searches of additional resources resulted in the identification of six additional citations. After study selection, eight studies were included in the review. Together, these studies show that patients with CC use more healthcare resources and incur greater costs than patients with non-CC. Most CC patients are managed in a primary care setting, with up to half referred to one or more specialists. CC patients are most often treated with opiates or other narcotics and receive an average of 2.1 diagnostic tests, with most undergoing chest x-ray and many undergoing advanced chest imaging. The average direct cost incurred by patients with CC was reported to be £1,800 GBP in the United Kingdom and $1,319 in the United States.

Conclusions: There is a paucity of research on HCRU and cost associated with CC. The available evidence indicates that CC and its treatment are associated with high HCRU, often involving multiple patient referrals, diagnostic tests, and prescriptions, including opiates, which imposes a large economic burden on both patients and healthcare systems. There is a considerable need for more effective therapies for reducing economic burden due to CC.