Incremental third-party costs associated with COPD exacerbations: a retrospective claims analysis

Abstract

Background:

Exacerbations are a major contributor to the large burden of treating chronic obstructive pulmonary disease (COPD). Estimates of exacerbation costs in the United States are limited.

Objective:

To estimate incremental costs associated with COPD exacerbation, particularly severe exacerbation, in the United States.

Methods:

COPD patients with at least one exacerbation were identified in the Thomson Reuters MarketScan administrative claims database. A COPD exacerbation was defined as patient use of oral or parenteral corticosteroids on the same day or within 7 days following a claim with a COPD diagnosis. Severe exacerbation was further defined if the exacerbation was associated with hospitalization or death. Healthcare costs and exacerbations were evaluated at quarterly intervals starting from patients’ first observed claim with COPD diagnostic code in the database. Incremental costs associated with exacerbation were estimated as cost differences between quarters with exacerbation and quarters without exacerbation.

Results:

A total of 2644,174 patient-quarters, derived from 228,978 COPD patients, were included in the analysis. The average patient was followed an average of 2.9 years. The mean total cost was $17,016 per patient-quarter with severe exacerbation, $6628 per patient-quarter with non-severe exacerbation, an average of $8726 per patient-quarters with any exacerbation compared to $4762 per patient-quarter with no exacerbation. After adjusting for patient demographics, the mean incremental total cost was $11,261 per patient-quarter with severe exacerbation, $1509 per patient-quarter for non-severe exacerbation, and $3439 per patient-quarter with any exacerbation compared with patient-quarters with no exacerbation.

Limitations:

The method used for defining exacerbations does not capture mild exacerbations. Additional limitations exist due to the nature of claims data.

Conclusions:

Exacerbations, especially severe ones, result in a significant economic burden for third-party payers. Effective management of COPD and prevention of exacerbations may lead to improved patient outcomes and reduction in total healthcare costs for long-term management of COPD.

Key words::

• Chronic obstructive pulmonary disease
• Claims analysis
• Costs
• Exacerbations

Transparency

Declaration of funding

This study was carried out by Analysis Group, Inc. Funding for this study was provided by Forest Research Institute. A.P.Y., E.Q.W., H.Y., J.S., M.M., and S.B. contributed to the conception and design of this study; H.Y. and A.P.Y. performed data analysis; A.P.Y., E.Q.W., H.Y., J.S., M.M., and S.B. provided data interpretation; and A.P.Y., E.Q.W., H.Y., J.S., M.M., and S.B. wrote and approved the manuscript.

Declaration of financial/other relationships

A.P.Y., H.Y., and E.Q.W. are employees of Analysis Group Inc., which has received consulting fees from Forest Research Institute for research related to this manuscript. J.S. was an employee of Forest Research Institute when this study was conducted. M.M. and S.B. are employees of Forest Research Institute.

Acknowledgments

A prior version of this study was presented in poster form at the 15th annual international meeting of the International Society for Pharmacoeconomics and Outcomes Research, May 15–19, 2010, in Atlanta, GA, USA. Prescott Medical Communications Group (Chicago, IL, USA) provided editorial assistance funded by Forest Research Institute.