The health care burden of high grade chronic obstructive pulmonary disease in Korea: analysis of the Korean Health Insurance Review and Assessment Service data

Figures & data

Figure 1 Changes in number of high grade and nonhigh grade COPD patients during the years 2006–2010.

Table 1 Sociodemographic and clinical characteristics of patients studied

	High grade COPD (n = 9,694)	Nonhigh grade COPD (n = 177,561)	P-value
Male, n (%)	7,627 (78.7%)	109,821 (61.8%)	<0.001
Age, years
Mean ± SD	69.4 ± 9.6	69.9 ±10.7	<0.001
Age, n (%)
40–49 years	333 (3.4%)	7,978 (4.5%)
50–59 years	1,167 (12.0%)	21,116 (11.9%)
60–69 years	2,976 (30.7%)	48,418 (27.3%)
70–79 years	3,904 (40.3%)	68,830 (38.8%)
≥80 years	1,314 (13.6%)	31,219 (17.6%)
Insurance type			<0.001
Health insurance	7,865 (81.1%)	148,373 (83.6%)
Medical aid	1,829 (18.9%)	29,188 (16.4%)
Comorbidity
Ischemic heart disease	1,207 (12.5%)	14,682 (8.3%)	<0.001
Congestive heart failure	721 (7.4%)	9,755 (5.5%)	<0.001
Hypertension	3,418 (35.3%)	50,435 (28.4%)	<0.001
Osteoporosis	736 (7.6%)	8,434 (4.7%)	<0.001
Depressive disorder	342 (2.1%)	3,022 (1.7%)	<0.001
Arthritis	298 (3.1%)	6,600 (3.7%)	0.001
Diabetes mellitus	1,740 (13.4%)	22,260 (12.5%)	<0.001
Anemia	208 (2.1%)	2,721 (1.5%)	<0.001
Metabolic syndrome	732 (7.6%)	10,902 (6.1%)	<0.001

Note: Data are expressed as mean ± standard error or number of patients with percentage in parentheses.

Abbreviations: COPD, chronic pulmonary obstructive disease; SD, standard deviation.

Table 2 Health care resource utilization of COPD patients according to grade of disease

	High grade COPD (n = 9,694)	Nonhigh grade COPD (n = 177,561)	P-value
History of hospitalization (yes)†	5,331 (55.0%)	37,564 (21.2%)	<0.001
History of ICU admission (yes)†	74 (0.8%)	587 (0.3%)	<0.001
History of ER visit (yes)	3,363 (34.7%)	15,399 (8.7%)	<0.001
Number of visits (%)			<0.001
0 visit	6,331 (65.3%)	162,162 (91.3%)
1–2 visits	2,855 (29.5%)	14,379 (8.1%)
3≥ visits	508 (5.3%)	1,020 (0.6%)
Last year hospitalization (yes)*	2,969 (30.6%)	20,654 (11.6%)	<0.001
Last year ER visit (yes)	1,751 (18.1%)	8,658 (4.9%)	<0.001
Used days
Outpatient services	9.6 ± 9.8	7.4 ± 8.6	<0.001
Inpatient services	30.0 ± 38.1	24.6 ± 35.8	<0.001
Total used days	26.0 ± 33.8	12.5 ± 21.0	<0.001

Notes: Data are expressed as mean ± standard error or number of patients with percentage in parentheses.

† Represents number of patients who were hospitalized, cared for in ICU, and visited ER in the year 2009

* represents number of patients who were hospitalized in the year 2008.

Abbreviations: COPD, chronic pulmonary obstructive disease; ER, emergency room; ICU, intensive care unit.

Table 3 Comparison of different components of medical cost between high grade and nonhigh grade COPD patients (per patient)

	High grade COPD		Nonhigh grade COPD		P-value
	Cost (US$)	%	Cost (US$)	%
Outpatient services
Laboratory examination	53.2	4.6%	23.1	4.5%
Radiologic examination	16.5	1.4%	7.0	1.4%
Medication	979.0	83.9%	401.5	78.9%
Others	116.9	10.1%	77.1	15.2%
Total	1,166.2	100%	508.7	100%	<0.001
Inpatient services
Medical examination	522.9	20.3%	113.0	16.7%
Radiologic examination	93.5	3.6%	25.7	3.8%
Medication	712.0	27.6%	176.2	26.1%
Others	1,250.3	48.5%	355.1	53.4%
Total	2,578.6	100%	647.7	100%	<0.001
Total
Medical examination	576.1	15.4%	136.1	11.5%
Radiologic examination	111.0	2.9%	32.7	2.8%
Medication	1,691.0	45.2%	577.7	48.8%
Others	1,367.7	36.5%	436.9	36.9%
Total	3,744.8	100%	1,183.4	100%	<0.001

Note: Medical examination includes laboratory examinations, pulmonary function tests, and echocardiography but not radiologic examination.

Abbreviation: COPD, chronic pulmonary obstructive disease.

Table 4 Pattern of COPD related drug use and costs by grade

Drug	High grade COPD		Nonhigh grade COPD		P-value†
	n (%)	Cost (US$)a	n (%)	Cost (US$)a
ICS	2,552 (26.3)	14.0 ± 23.1	16,232 (9.1)	3.6 ± 6.7	<0.001
ICS + LABA	7,205 (74.3)	206.2 ± 142.0	48,933 (27.6)	57.5 ± 46.1	<0.001
LAMA	9,691 (99.9)	259.3 ± 344.3	44,054 (24.8)	59.5 ± 80.0	<0.001
LABA	16 (0.2)	0.1 ± 0.1	122 (0.1)	0.1 ± 0.0	0.284
LTRA	3,684 (38.0)	81.0 ± 61.8	29,260 (16.5)	24.7 ± 24.6	<0.001
OCS	9,690 (99.9)	8.7 ± 22.6	38,810 (21.9)	1.0 ± 2.8	<0.001
SAMA	4,209 (43.4)	13.6 ± 41.4	24,523 (13.8)	3.0 ± 5.8	<0.001
SABA	6,241 (64.4)	15.4 ± 28.2	45,866 (25.8)	3.6 ± 20.2	<0.001
SABA + SAMA	422 (4.35)	2.1 ± 2.6	4,036 (2.3)	1.0 ± 1.3	<0.001
Oral beta-2 agonist	4,655 (48.0)	22.9 ± 29.9	80,709 (45.5)	12.2 ± 21.3	<0.001
Methylxanthine	8,360 (86.2)	47.5 ± 39.6	137,937 (77.7)	22.4 ± 28.6	<0.001
Total cost		671.0		188.4

Notes:

† P-value is for the comparison of cost per patient

a represents cost per patient.

Abbreviations: ICS, inhaled corticosteroids; COPD, chronic pulmonary obstructive disease; LABA, long-acting beta-2 agonist; LAMA, long-acting muscarinic antagonist; LTRA, leukotriene antagonist; OCS, oral corticosteroids; SABA, short-acting beta-2 agonist; SAMA, short-acting muscarinic antagonist.

Table 5 Multiple linear regression for factors affecting days of health care use

Variable	Unadjusted			Adjusted
	β	exp(β)	P-value	β	exp(β)	P-value
Last year hospitalization	0.834	2.302	<0.0001	0.669	1.935	<0.001
COPD grade	0.781	2.184	<0.0001	0.622	1.862	<0.001
Age (year)	0.138	1.148	<0.0001	0.125	1.133	<0.001
Last year	0.799	2.224	<0.0001	0.061	1.063	<0.001
ER visit
Male	0.013	1.013	<0.0001	0.011	1.011	<0.001

Abbreviations: COPD, chronic pulmonary obstructive disease; ER, emergency room; exp, exponentiated regression coefficients.