Healthcare utilization and costs among chronic bronchitis patients treated with maintenance medications from a US managed care population

Abstract

Objectives:

This study aimed to examine the real-world healthcare resource utilization (HCRU) and direct costs among chronic bronchitis (CB) patients treated with chronic obstructive pulmonary disease (COPD) maintenance medications.

Methods:

This retrospective analysis utilized administrative claims data from 14 US commercial managed care plans. Eligible patients were ≥40 years old, had ≥2 years of continuous enrollment, ≥1 CB (ICD-9-CM code 491.xx) hospitalization or emergency department (ED) visit or ≥2 office visits between 1/1/2004 and 5/31/2011, and had ≥2 pharmacy fills for COPD medications during follow-up (first fill served as the index date). All-cause and COPD-related HCRU and costs were assessed during follow-up. Multivariate models were utilized to identify predictors of total costs.

Results:

Treated CB patients (n = 17,382; 50.6% female; mean age 66.7 (SD = 11.4) years) had a mean of 7.6 (SD = 6.3) COPD maintenance medication fills during follow-up. Overall, 32.6% of patients had ≥1 COPD-related inpatient hospitalizations, 12.9% had ≥1 ED visit, and 81.8% had ≥1 office visit. Mean all-cause and COPD-related total costs were $25,747 (SD = $51,105) and $12,609 (SD = $36,801), respectively, during follow-up. Among the sub-group with ≥1 exacerbation during baseline year, 42.3% had ≥1 COPD-related inpatient hospitalization, 18.5% had ≥1 ED visit, and 88.2% had ≥1 office visit. Mean follow-up all-cause and COPD-related total costs were $29,861 (SD = $49,799) and $16,784 (SD = $34,170), respectively. The number of baseline exacerbations was a significant predictor of all-cause and COPD-related total costs during follow-up.

Limitations:

This study lacked standard measures of CB severity; however, severity proxies were utilized.

Conclusion:

HCRU and costs among CB patients were substantial during follow-up, despite treatment with COPD maintenance medications. Additional interventions aiming to prevent or reduce HCRU and costs among CB patients warrant exploration.

Keywords::

• Chronic bronchitis
• COPD maintenance medications
• Healthcare utilization and costs

Transparency

Declaration of funding

This research project was funded by Forest Research Institute (Jersey City, NJ), a wholly owned subsidiary of Forest Laboratories, Inc. (New York, NY).

Declaration of financial/other relationships

SXS is an employee of Forest Research Institute. The other authors (AA, HT, CTS) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. The funding sponsor had no role in data collection, interpretation, or analysis, nor did the sponsor influence the manuscript or the decision to publish. AA and HT are employees of HealthCore, Inc. (Wilmington, DE), an independent outcomes research organization. CTS is an employee of Pharmerit North America (Bethesda, MD), an independent outcomes research organization. Both HealthCore, Inc. and Pharmerit North America received consulting fees from Forest Research Institute for research related to this manuscript. JME peer reviewers on this manuscript have no relevant relationships to disclose.

Acknowledgments

The authors thank Rebecca Cobb for programming efforts and Cheryl Jones for editorial assistance in preparing this manuscript. Assistance with preparation of the manuscript for submission by Prescott Medical Communications Group (Chicago, IL) was made possible by funding from Forest Research Institute. Data presented in this manuscript were previously presented in part as a poster at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 17th Annual International Meeting; June 2–6, 2012; Washington, DC.