Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

Abstract

Background

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for lung infections and other pathologies (eg, pneumonia); however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia.

Methods

A retrospective claims analysis using Truven MarketScan^® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index), and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits), and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching.

Results

In the baseline cohort (N=467,578), patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years) and had higher Charlson Comorbidity Index scores (3.3 vs 2.6) than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely to have a hospitalization (odds ratio; 95% confidence intervals [CI] =9.2; 8.9, 9.4) and four times more likely to have an ER visit (odds ratio; 95% CI =4.4; 4.3, 4.5) over the 12-month follow-up period compared to the control cohort. The estimated 12-month mean hospitalization costs ($14,353 [95% CI: $14,037–$14,690]), outpatient costs ($6,891 [95% CI: $6,706–$7,070]), and prescription drug costs ($1,104 [95% CI: $1,054–$1,142]) were higher in the pneumonia cohort than in the control cohort.

Conclusion

This study demonstrated elevated health care resource use and costs in patients with COPD after acquiring pneumonia compared to those without pneumonia.

Keywords:

• COPD
• health care costs
• cost effectiveness/economics
• outcomes research

Acknowledgments

We thank Write All, Inc., the company that provided editorial and written services on behalf of Novartis Pharmaceuticals Corporation.

Author contributions

Junji Lin, Yunfeng Li, Haijun Tian, Michael J Goodman, Susan Gabriel, Tara Nazareth, Stuart J Turner, Stephen Arcona, and Kristijan H Kahler were involved in the initiation of the study and in the definition of the study objective and search strategy. Each of the authors also aided in conducting the study analysis and interpreting the study results and wrote and critically reviewed the manuscript. All authors have read and approved the entire manuscript, and are accountable for all aspects of the work.

Disclosure

Junji Lin was a Novartis Data Analytics Fellow at University of Utah and Stuart J Turner was a Novartis Outcomes Research Fellow at Rutgers University. Both Fellows did this research as a part of their Fellowship and were both funded by Novartis Pharmaceuticals Corporation. Yunfeng Li, Haijun Tian, Susan Gabriel, Tara Nazareth, Stuart J Turner, Stephen Arcona, and Kristijan H Kahler are employees of Novartis Pharmaceuticals Corporation. Michael J Goodman is an assistant professor in the Department of Pharmacotherapy at the University of Utah. Written and editorial support for the preparation of this manuscript was provided by Write All, Inc., who received funding for services from Novartis Pharmaceuticals Corporation. The authors report no other conflicts of interest in this work.