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Comparative Study
. 2010 Oct 5:5:341-9.
doi: 10.2147/COPD.S13771.

Direct costs of chronic obstructive pulmonary disease among managed care patients

Anand A Dalal  1 , Laura Christensen, Fang Liu, Aylin A Riedel
Affiliations
Comparative Study

Direct costs of chronic obstructive pulmonary disease among managed care patients

Anand A Dalal et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD) among commercially insured patients in the US.

Methods: In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days), emergency department (ED), standard inpatient admission, and intensive care unit (ICU) cohorts. Patient- level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated.

Results: Of the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD) annual COPD-related health care costs (2008 US$) increased across the cohorts (P < 0.001), ranging from $2003 ($3238) to $43,461 ($76,159) per patient. Medical costs comprised 96% of health care costs for the ICU cohort. Adjusted mean (SD) episode-level costs were $305 ($310) for an outpatient visit, $274 ($336) for an urgent outpatient visit, $327 ($65) for an ED visit, $9745 ($2968) for a standard admission, and $33,440 for an ICU stay.

Conclusion: Direct costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs.

Keywords: health care cost; health expenditure; lung diseases; managed care.

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Figures

Figure 1
Figure 1
Mean annual COPD-related medical, pharmacy, and total costs by care intensity cohort. P < 0.001 among cohorts for medical costs, P < 0.001 among cohorts for pharmacy costs, and P < 0.001 among cohorts for total COPD-related costs. Abbreviations: ED, emergency department; ICU, intensive care unit; COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Mean annual patient-level cost of COPD-related visits by care intensity cohort. Among-cohort P < 0.001 for costs associated with each type of visit. Abbreviations: ED, emergency department; ICU, intensive care unit; COPD, chronic obstructive pulmonary disease.
Figure 3
Figure 3
Mean annual patient-level COPD-related health care costs by race. Among-group P < 0.001 for pharmacy costs, P = 0.581 for medical costs, P = 0.135 for combined medical and pharmacy costs. Abbreviation: COPD, chronic obstructive pulmonary disease.
Figure 4
Figure 4
Adjusted episode-level cost of COPD-related visits. Abbreviations: ED, emergency department; ICU, intensive care unit; COPD, chronic obstructive pulmonary disease.
See this image and copyright information in PMC

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