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Burden of chronic obstructive pulmonary disease in Medicare beneficiaries residing in long-term care facilities.
Am J Geriatr Pharmacother. 2009 Oct; 7(5):262-70.AJ

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD increases health care resource utilization and spending and adversely affects quality of life. Data from the clinical and economic outcomes in Medicare beneficiaries with COPD who reside in long-term care (LTC) facilities are limited.

OBJECTIVE

The purpose of this study was to investigate the clinical and economic outcomes associated with COPD in Medicare beneficiaries residing in LTC facilities.

METHODS

This retrospective cohort study analyzed data from MarketScan Medicaid, a large US administrative claims database containing data on Medicaid programs in 8 states. The study cohort comprised LTC facility residents aged > or =60 years who had a diagnosis of COPD. Eligible patients also had a prescription filled between January 1, 2003, and June 30, 2005, for one of the following COPD treatments: fluticasone propionate + salmeterol xinafoate, tiotropium bromide, ipratropium bromide, or ipratropium bromide + albuterol sulfate. The date of the first prescription fill was considered the index date. Measures of health care resource utilization included COPD-related and all-cause hospitalizations and emergency department (ED) visits. Cost analysis outcomes included COPD-related and all-cause inpatient, outpatient, pharmacy, LTC, and total costs during the 12-month postindex period.

RESULTS

Data from 3037 patients were included (63.0% women; 82.2% white; mean [SD] age, 78.1 [10.0] years). A total of 43.3% of patients had > or =1 hospitalization; 90.0%, > or =1 ED visit. With the exception of age <70 years, age was associated with all-cause hospitalization (age 70-<75 years, hazard ratio [HR] = 1.31 [95% CI, 1.03-1.68]; age 75-<80 years, HR = 1.40 [95% CI, 1.11-1.78]; age > or =80 years, HR = 1.48 [95% CI, 1.19-1.85]). Age was not associated with COPD-related hospitalization, all-cause ED visits, or COPD-related ED visits. The risk for all-cause hospitalization in white patients was significantly lower compared with that in nonwhite patients (HR = 0.79 [95% CI, 0.69-0.91]). Patients with comorbid asthma had a higher risk for a COPD-related ED visit (HR = 1.34 [95% CI, 1.08-1.66]) than did patients without asthma. Preindex all-cause hospitalization was associated with COPD-related hospitalization (HR = 1.78 [95% CI, 1.49-2.14]) and all-cause hospitalization (HR = 2.05 [95% CI, 1.932.19]). Twelve-month COPD-related and all-cause direct expenditures per beneficiary were US $7391 and $48,183. In COPD-related and all-cause estimates, mean (SD) LTC costs were the largest cost components ($5629 [$12,562] and $32,966 [$14,871], respectively), followed by pharmacy costs ($956 [$957] and $5565 [$3873]), inpatient costs ($466 [$3393] and $6436 [$22,603]), and outpatient costs ($341 [$1793] and $3216 [$6458]).

CONCLUSION

This study found that the utilization of health care resources and economic burden of LTC residents with COPD were primarily due to LTC, pharmacy, and inpatient costs.

Authors+Show Affiliations

Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland 21201, USA. lsimoniw@rx.umaryland.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19948302

Citation

Simoni-Wastila, Linda, et al. "Burden of Chronic Obstructive Pulmonary Disease in Medicare Beneficiaries Residing in Long-term Care Facilities." The American Journal of Geriatric Pharmacotherapy, vol. 7, no. 5, 2009, pp. 262-70.
Simoni-Wastila L, Blanchette CM, Qian J, et al. Burden of chronic obstructive pulmonary disease in Medicare beneficiaries residing in long-term care facilities. Am J Geriatr Pharmacother. 2009;7(5):262-70.
Simoni-Wastila, L., Blanchette, C. M., Qian, J., Yang, H. W., Zhao, L., Zuckerman, I. H., Pak, G. H., Silver, H., & Dalal, A. A. (2009). Burden of chronic obstructive pulmonary disease in Medicare beneficiaries residing in long-term care facilities. The American Journal of Geriatric Pharmacotherapy, 7(5), 262-70. https://doi.org/10.1016/j.amjopharm.2009.11.003
Simoni-Wastila L, et al. Burden of Chronic Obstructive Pulmonary Disease in Medicare Beneficiaries Residing in Long-term Care Facilities. Am J Geriatr Pharmacother. 2009;7(5):262-70. PubMed PMID: 19948302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Burden of chronic obstructive pulmonary disease in Medicare beneficiaries residing in long-term care facilities. AU - Simoni-Wastila,Linda, AU - Blanchette,Christopher M, AU - Qian,Jingjing, AU - Yang,Hui-Wen Keri, AU - Zhao,Lirong, AU - Zuckerman,Ilene H, AU - Pak,Grace H, AU - Silver,Harris, AU - Dalal,Anand A, PY - 2009/08/18/accepted PY - 2009/12/2/entrez PY - 2009/12/2/pubmed PY - 2010/1/29/medline SP - 262 EP - 70 JF - The American journal of geriatric pharmacotherapy JO - Am J Geriatr Pharmacother VL - 7 IS - 5 N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD increases health care resource utilization and spending and adversely affects quality of life. Data from the clinical and economic outcomes in Medicare beneficiaries with COPD who reside in long-term care (LTC) facilities are limited. OBJECTIVE: The purpose of this study was to investigate the clinical and economic outcomes associated with COPD in Medicare beneficiaries residing in LTC facilities. METHODS: This retrospective cohort study analyzed data from MarketScan Medicaid, a large US administrative claims database containing data on Medicaid programs in 8 states. The study cohort comprised LTC facility residents aged > or =60 years who had a diagnosis of COPD. Eligible patients also had a prescription filled between January 1, 2003, and June 30, 2005, for one of the following COPD treatments: fluticasone propionate + salmeterol xinafoate, tiotropium bromide, ipratropium bromide, or ipratropium bromide + albuterol sulfate. The date of the first prescription fill was considered the index date. Measures of health care resource utilization included COPD-related and all-cause hospitalizations and emergency department (ED) visits. Cost analysis outcomes included COPD-related and all-cause inpatient, outpatient, pharmacy, LTC, and total costs during the 12-month postindex period. RESULTS: Data from 3037 patients were included (63.0% women; 82.2% white; mean [SD] age, 78.1 [10.0] years). A total of 43.3% of patients had > or =1 hospitalization; 90.0%, > or =1 ED visit. With the exception of age <70 years, age was associated with all-cause hospitalization (age 70-<75 years, hazard ratio [HR] = 1.31 [95% CI, 1.03-1.68]; age 75-<80 years, HR = 1.40 [95% CI, 1.11-1.78]; age > or =80 years, HR = 1.48 [95% CI, 1.19-1.85]). Age was not associated with COPD-related hospitalization, all-cause ED visits, or COPD-related ED visits. The risk for all-cause hospitalization in white patients was significantly lower compared with that in nonwhite patients (HR = 0.79 [95% CI, 0.69-0.91]). Patients with comorbid asthma had a higher risk for a COPD-related ED visit (HR = 1.34 [95% CI, 1.08-1.66]) than did patients without asthma. Preindex all-cause hospitalization was associated with COPD-related hospitalization (HR = 1.78 [95% CI, 1.49-2.14]) and all-cause hospitalization (HR = 2.05 [95% CI, 1.932.19]). Twelve-month COPD-related and all-cause direct expenditures per beneficiary were US $7391 and $48,183. In COPD-related and all-cause estimates, mean (SD) LTC costs were the largest cost components ($5629 [$12,562] and $32,966 [$14,871], respectively), followed by pharmacy costs ($956 [$957] and $5565 [$3873]), inpatient costs ($466 [$3393] and $6436 [$22,603]), and outpatient costs ($341 [$1793] and $3216 [$6458]). CONCLUSION: This study found that the utilization of health care resources and economic burden of LTC residents with COPD were primarily due to LTC, pharmacy, and inpatient costs. SN - 1876-7761 UR - https://www.unboundmedicine.com/medline/citation/19948302/Burden_of_chronic_obstructive_pulmonary_disease_in_Medicare_beneficiaries_residing_in_long_term_care_facilities_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1543-5946(09)00072-5 DB - PRIME DP - Unbound Medicine ER -