Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009

Figures & data

Table 1 Characteristics of patients with chronic obstructive pulmonary disease and commercial insurance or Medicare

	2009
	Commercial (N = 51,210)		Medicare (N = 42,166)
	n	%	n	%
Male	24,597	48.0	18,503	43.9
Region
Northeast	5168	10.1	5262	12.5
Midwest	11,972	23.4	14,880	35.3
South	27,345	53.4	18,499	43.9
West	6725	13.1	3525	8.4
Age group
40–49	5581	10.9	717	1.7
50–64	26,933	52.6	5493	13.0
65–74	9919	19.4	17,605	41.8
≥75	8777	17.1	18,351	43.5
Age; mean, SD	62.7	11.1	72.7	9.2
Comorbidities
Asthma	16,148	31.5	12,318	29.2
Chronic bronchitis	22,365	43.7	19,324	45.8
Emphysema	9711	19.0	9343	22.2
Chronic airway obstructiona	43,045	84.1	38,821	92.1
Quan-Charlson index; mean, SD	2.5	1.9	3.3	2.3

a Note: Not elsewhere specified.

Abbreviation: SD, standard deviation.

Figure 1 Mean annual unadjusted patient-level chronic obstructive pulmonary disease-related health care costs for patients with commercial insurance or Medicare Advantage.

Note: Costs are adjusted to year 2008 and are in USD.

Table 2 Adjusted chronic obstructive pulmonary disease-related subject-level and visit-level cost ratios with year as primary predictor

	Commercial 2006–2009		P	Medicare 2007–2009		P
	Cost ratio	95% CI		Cost ratio	95% CI
Subject level
Medical	1.06	1.04–1.09	< 0.0001	1.07	1.05–1.10	<0.001
Pharmacy	1.05	1.04–1.05	< 0.0001	0.99	0.98–1.00	0.17
Total	1.06	1.04–1.07	< 0.0001	1.05	1.03–1.07	<0.001
Visit level
Outpatient	1.06	1.04–1.07	< 0.0001	1.02	1.00–1.04	0.05
Urgent outpatient	1.07	1.05–1.10	< 0.0001	1.09	1.04–1.14	0.001
Emergency department	1.04	1.02–1.06	0.001	1.06	1.03–1.09	<0.001
Standard admission	1.01	0.98–1.03	0.59	1.03	1.00–1.05	0.03
Intensive care unit	1.02	0.97–1.08	0.38	1.00	0.93–1.08	0.97

Notes: Generalized linear models adjusted for age, sex, and region. Total costs increased by approximately 6% per year for commercial insurance patients and 5% per year for Medicare patients.

Abbreviation: CI, confidence interval.

Figure 2 Mean unadjusted visit-level costs of nonhospital chronic obstructive pulmonary disease-related visits in 2006 through 2009 for patients with commercial insurance or Medicare Advantage.

Note: Costs are adjusted to year 2008 and are in USD.

Figure 3 Mean unadjusted visit-level costs of chronic obstructive pulmonary disease-related standard admission (no intensive care unit) and intensive care unit visits in 2006 through 2009 for patients with commercial insurance or Medicare Advantage.

Note: Costs are adjusted to year 2008 and are in USD.

Appendix 1 Characteristics of patients with chronic obstructive pulmonary disease by insurance type

	2006		2007				2008
	Commercial (N = 47,147)		Commercial (N = 49,661)		Medicare (N = 24,222)		Commercial (N = 52,056)		Medicare (N = 30,183)
	n	%	n	%	n	%	n	%	n	%
Male	23,014	48.8	24,080	48.5	10,783	44.5	25,126	48.3	13,308	44.1
Region
Northeast	5240	11.1	5496	11.1	2638	10.9	5541	10.6	3505	11.6
Midwest	12,966	27.5	12,412	25.0	10,705	44.2	12,760	24.5	11,579	38.4
South	21,970	46.6	25,250	50.8	10,109	41.7	26,861	51.6	13,501	44.7
West	6971	14.8	6503	13.1	770	3.2	6894	13.2	1598	5.3
Age group
40–49	6269	13.3	5972	12.0	360	1.5	5776	11.1	466	1.5
50–64	24,864	52.7	25,789	51.9	2648	10.9	26,851	51.6	3703	12.3
65–74	8670	18.4	9619	19.4	9767	40.3	10,454	20.1	12,089	40.1
≥75	7344	15.6	8281	16.7	11,447	47.3	8975	17.2	13,925	46.1
Age; mean, SD	61.8	11.0	62.4	11.1	73.4	8.7	62.7	11.1	73.1	9.0
Comorbidities
Asthma	15,355	32.6	15,905	32.0	6572	27.1	16,714	32.1	8423	27.9
Chronic bronchitis	20,068	42.6	20,942	42.2	10,225	42.2	22,929	44.0	13,907	46.1
Emphysema	9494	20.1	9861	19.9	5444	22.5	10,045	19.3	6863	22.7
Chronic airway obstructiona	38,904	82.5	41,537	83.6	22,260	91.9	43,441	83.5	27,746	91.9
Quan-Charlson index; mean, SD	2.3	1.8	2.4	1.9	3.2	2.2	2.4	1.9	3.3	2.3

a Note: Not elsewhere specified.

Abbreviation: SD, standard deviation.

Appendix 2 Unadjusted visit-level costs of chronic obstructive pulmonary disease-related visits in 2006 through 2009 for patients with commercial insurance or Medicare Advantage

Visit type	Year	Commercial					Medicare
		Mean	SD	25th percentile	Median	75th percentile	Mean	SD	25th percentile	Median	75th percentile
Outpatient	2006	306	1366	54	89	171	–	–	–	–	–
	2007	313	1284	55	90	175	178	614	59	87	122
	2008	332	1475	56	93	180	183	667	58	86	121
	2009	363	1638	58	95	185	186	628	58	86	120
Urgent outpatient	2006	277	1208	57	92	158	–	–	–	–	–
	2007	279	1253	57	91	157	230	1050	60	89	124
	2008	309	1364	59	94	165	248	1159	59	87	122
	2009	340	1572	61	97	168	266	1244	61	87	123
Emergency department	2006	315	460	109	226	394	–	–	–	–	–
	2007	302	388	115	233	389	375	451	89	265	488
	2008	332	348	156	274	428	409	463	126	296	532
	2009	345	331	158	290	454	429	504	157	309	567
Standard admission	2006	9799	13,644	3078	6246	10,492	–	–	–	–	–
	2007	10,579	19,850	2906	6337	10,890	6968	6283	4907	5677	6910
	2008	9936	12,783	3206	6913	11,522	7353	7289	4707	5856	7518
	2009	10,170	12,755	3598	6958	11,453	7430	6098	4593	6059	8122
Intensive care unit	2006	35,583	73,705	6308	12,061	34,114	–	–	–	–	–
	2007	38,438	91,401	6613	13,854	33,135	14,085	31,018	5517	6573	12,289
	2008	38,198	81,996	7198	14,367	32,669	14,532	20,966	5714	7407	13,880
	2009	39,229	78,548	7927	14,560	35,979	14,112	22,885	5553	7824	12,650

Note: All values are USD.

Abbreviation: SD, standard deviation.