COPD exacerbation frequency and its association with health care resource utilization and costs

Abstract

Background

Chronic obstructive pulmonary disease (COPD) exacerbations account for a substantial proportion of COPD-related costs.

Objective

To describe COPD exacerbation patterns and assess the association between exacerbation frequency and health care resource utilization (HCRU) and costs in patients with COPD in a Medicare population.

Methods

A retrospective cohort study utilizing data from a large US national health plan was conducted including patients with a COPD diagnosis during January 1, 2007 to December 31, 2012, aged 40–89 years and continuously enrolled in a Medicare Advantage Prescription Drug plan. Exacerbation frequency, HCRU, and costs were assessed during a 24-month period following the first COPD diagnosis (follow-up period). Four cohorts were created based on exacerbation frequency (zero, one, two, and ≥three). HCRU and costs were compared among the four cohorts using chi-square tests and analysis of variance, respectively. A trend analysis was performed to assess the association between exacerbation frequency and costs using generalized linear models.

Results

Of the included 52,459 patients, 44.3% had at least one exacerbation; 26.3%, 9.5%, and 8.5% had one, two, and ≥three exacerbations in the 24-month follow-up period, respectively. HCRU was significantly different among cohorts (all P<0.001). In patients with zero, one, two, and ≥three exacerbations, the percentages of patients experiencing all-cause hospitalizations were 49.7%, 66.4%, 69.7%, and 77.8%, respectively, and those experiencing COPD-related hospitalizations were 0%, 40.4%, 48.1%, and 60.5%, respectively. Mean all-cause total costs (medical and pharmacy) were more than twofold greater in patients with ≥three exacerbations compared to patients with zero exacerbations ($27,133 vs $56,033; P<0.001), whereas a greater than sevenfold difference was observed in mean COPD-related total costs ($1,605 vs $12,257; P<0.001).

Conclusion

COPD patients frequently experience exacerbations. Increasing exacerbation frequency is associated with a multiplicative increase in all-cause and COPD-related costs. This underscores the importance of identifying COPD patients at risk of having frequent exacerbations for appropriate disease management.

Keywords:

• COPD
• exacerbations
• frequency
• costs

Disclosure

Amol D Dhamane, Kate Burslem and Shuchita Kaila are employees of Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA. Gagan Jain was an employee of Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA at the time of the study. Chad Moretz, Yunping Zhou and Kim Saverno are employees of Comprehensive Health Insights Inc., Louisville, KY, USA. Andrew Renda is an employee of Humana Inc., Louisville, KY, USA. The authors report no other conflicts of interest in this work.