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Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population.

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.

Authors+Show Affiliations

Competitive Health Analytics, Louisville, KY 40202, USA. mpasquale@humana.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23152680

Citation

Pasquale, Margaret K., et al. "Impact of Exacerbations On Health Care Cost and Resource Utilization in Chronic Obstructive Pulmonary Disease Patients With Chronic Bronchitis From a Predominantly Medicare Population." International Journal of Chronic Obstructive Pulmonary Disease, vol. 7, 2012, pp. 757-64.
Pasquale MK, Sun SX, Song F, et al. Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. Int J Chron Obstruct Pulmon Dis. 2012;7:757-64.
Pasquale, M. K., Sun, S. X., Song, F., Hartnett, H. J., & Stemkowski, S. A. (2012). Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. International Journal of Chronic Obstructive Pulmonary Disease, 7, 757-64. https://doi.org/10.2147/COPD.S36997
Pasquale MK, et al. Impact of Exacerbations On Health Care Cost and Resource Utilization in Chronic Obstructive Pulmonary Disease Patients With Chronic Bronchitis From a Predominantly Medicare Population. Int J Chron Obstruct Pulmon Dis. 2012;7:757-64. PubMed PMID: 23152680.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. AU - Pasquale,Margaret K, AU - Sun,Shawn X, AU - Song,Frank, AU - Hartnett,Heather J, AU - Stemkowski,Stephen A, Y1 - 2012/11/01/ PY - 2012/11/16/entrez PY - 2012/11/16/pubmed PY - 2013/4/24/medline KW - COPD with chronic bronchitis KW - Medicare patients KW - moderate exacerbation KW - severe exacerbation SP - 757 EP - 64 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 7 N2 - 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. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/23152680/Impact_of_exacerbations_on_health_care_cost_and_resource_utilization_in_chronic_obstructive_pulmonary_disease_patients_with_chronic_bronchitis_from_a_predominantly_Medicare_population_ L2 - https://dx.doi.org/10.2147/COPD.S36997 DB - PRIME DP - Unbound Medicine ER -