Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population

Abstract

Background

Patients with chronic obstructive pulmonary disease (COPD) often have multiple underlying comorbidities, which may lead to increased health care resource utilization (HCRU) and costs.

Objective

To describe the comorbidity profiles of COPD patients and examine the associations between the presence of comorbidities and HCRU or health care costs.

Methods

A retrospective cohort study utilizing data from a large US national health plan with a predominantly Medicare population was conducted. COPD patients aged 40–89 years and continuously enrolled for 12 months prior to and 24 months after the first COPD diagnosis during the period of January 01, 2009, through December 31, 2010, were selected. Eleven comorbidities of interest were identified 12 months prior through 12 months after COPD diagnosis. All-cause and COPD-related hospitalizations and costs were assessed 24 months after diagnosis, and the associations with comorbidities were determined using multivariate statistical models.

Results

Ninety-two percent of 52,643 COPD patients identified had at least one of the 11 comorbidities. Congestive heart failure (CHF), coronary artery disease, and cerebrovascular disease (CVA) had the strongest associations with all-cause hospitalizations (mean ratio: 1.56, 1.32, and 1.30, respectively; P<0.0001); other comorbidities examined had moderate associations. CHF, anxiety, and sleep apnea had the strongest associations with COPD-related hospitalizations (mean ratio: 2.01, 1.32, and 1.21, respectively; P<0.0001); other comorbidities examined (except chronic kidney disease [CKD], obesity, and osteoarthritis) had moderate associations. All comorbidities assessed (except obesity and CKD) were associated with higher all-cause costs (mean ratio range: 1.07–1.54, P<0.0001). CHF, sleep apnea, anxiety, and osteoporosis were associated with higher COPD-related costs (mean ratio range: 1.08–1.67, P<0.0001), while CVA, CKD, obesity, osteoarthritis, and type 2 diabetes were associated with lower COPD-related costs.

Conclusion

This study confirms that specific comorbidities among COPD patients add significant burden with higher HCRU and costs compared to patients without these comorbidities. Payers may use this information to develop tailored therapeutic interventions for improved management of patients with specific comorbidities.

Keywords:

• COPD
• comorbidities
• utilization
• cost
• database
• Medicare

Acknowledgments

The authors thank Tristan Cordier, MPH, a full-time employee of Humana Inc. for assistance with Behavioral Risk Factor Surveillance System data used to age-adjust descriptive HCRU and cost statistics for the manuscript and Mary Costantino, PhD, a full-time employee of Comprehensive Health Insights, Inc. for assistance in the development, revisions, and editing of this manuscript.

Disclosure

This study was funded by Humana Inc. and Boehringer Ingelheim Pharmaceuticals Inc. Andrew Renda is an employee and shareholder of Humana Inc.; Amol D Dhamane, Kate Burslem, and Shuchita Kaila are employees of Boehringer Ingelheim Pharmaceuticals Inc.; Phil Schwab, Sari D Hopson, Chad Moretz, and Srinivas Annavarapu are employees of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc., who were paid consultants to Boehringer Ingelheim Pharmaceuticals Inc. in connection with the analysis described in this study and with manuscript development. The authors report no other conflicts of interest in this work.