Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population
Open Access
- 1 November 2012
- journal article
- Published by Informa UK Limited in International Journal of Chronic Obstructive Pulmonary Disease
- Vol. 7, 757-764
- https://doi.org/10.2147/copd.s36997
Abstract
Background: Exacerbations of chronic obstructive pulmonary disease (COPD) lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients. Methods: For this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40–89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx), and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics. Results: The final study sample involved 8554 patients; mean age was 70.1 ± 8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars) for the overall population and $6381 for patients with two or more exacerbations. All-cause health care costs were $18,976 for the overall population and $23,901 for patients with history of two or more exacerbations. Severity of exacerbations, presence of cardiovascular disease, diabetes, and long-term oxygen use were associated with higher adjusted costs. Conclusions: The results indicate that despite treatment with maintenance medications, COPD patients continue to have exacerbations resulting in higher costs. New medications and disease management interventions are warranted to reduce the severity and frequency of exacerbations and the related cost impact of the disease.Keywords
This publication has 24 references indexed in Scilit:
- Rehospitalization risks and outcomes in COPD patients receiving maintenance pharmacotherapyRespiratory Medicine, 2012
- Chronic obstructive pulmonary disease among adults aged 18 and over in the United States, 1998-2009.2011
- A New Method for Examining the Cost Savings of Reducing COPD ExacerbationsPharmacoEconomics, 2010
- Underreporting Exacerbation of Chronic Obstructive Pulmonary Disease in a Longitudinal CohortAmerican Journal of Respiratory and Critical Care Medicine, 2008
- Health-Related QOL in Acute Exacerbations of Chronic Bronchitis and Chronic Obstructive Pulmonary DiseasePharmacoEconomics, 2005
- Longitudinal changes in the nature, severity and frequency of COPD exacerbationsEuropean Respiratory Journal, 2003
- COPD exacerbations: definitions and classificationsEuropean Respiratory Journal, 2003
- Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary diseaseThorax, 2002
- Lower Respiratory Illnesses Promote FEV1 Decline in Current Smokers But Not Ex-Smokers with Mild Chronic Obstructive Pulmonary DiseaseAmerican Journal of Respiratory and Critical Care Medicine, 2001
- Health Care Utilization in Chronic Obstructive Pulmonary DiseaseArchives of Internal Medicine, 2000