[The public health cost of chronic obstructive pulmonary disease].

extent of the problem, justify the distribution of resources, and define a framework within which programs can be assessed. 1 The usefulness of this type of study is, however, debatable. 2 Knowing whether we spend a lot or a little on treating patients with a particular disease provides no information about the appropriate use of resources. A low expenditure could be insufficient to meet needs or a superfluous expense if it is being used to finance irrelevant programs or treatments. It would, therefore, seem more appropriate to direct our efforts towards economic analyses that relate expenditure to outcomes. The healthcare cost of treating patients with chronic obstructive pulmonary disease (COPD) will increase in the coming years, in terms of both direct and indirect costs. 3 In order to assess the real social impact of the cost of COPD, we would have to analyze certain specific aspects of the illness, the role played by variability, and the amount of the cost currently hidden as a consequence of underdiagnosis. During recent years, various papers have been published that attempt to analyze the breakdown of the expenditure on COPD. Strassels et al 4 report that 68% of the annual cost of treating patients with COPD is due to hospitalization. Furthermore, as would seem reasonable, the cost of treating COPD increases according to the severity of the patient's condition. 5 Soler et al 6 report that 12% of patients account for 57% of hospitalizations and nearly 60% of visits to emergency departments. Thus, when discussing the cost of COPD, we must take into account the cost of hospitalization. In Spain over 40% of the cost of treatment is related to hospitalization. 7 Analysis of the cost of admitting patients with COPD to our hospital reveals that hospitalization costs (the overhead of maintaining a hospital bed) represents 70% of the total cost of treating a patient admitted with this disease. 8 This means that medical treatment, medication, and tests account for less than a third of the total cost. In this case, optimization of resources cannot be achieved by reducing the number of tests, for example, but rather by the overall reduction of the days spent in hospital. A study carried out by Verdaguer et al 9 demonstrates the impact of variations in clinical practice within the hospital (with respect to avoidable hospital stays and the reduction of medication). These authors indicate that variations in …