Undertreatment of COPD: a retrospective analysis of US managed care and Medicare patients

Abstract

Background: We investigated a large population of patients with chronic obstructive pulmonary disease (COPD) to determine their frequency of medication use and patterns of pharmacotherapy.

Methods: Medical and pharmacy claims data were retrospectively analyzed from 19 health plans (>7.79 million members) across the US. Eligible patients were aged ≥40 years, continuously enrolled during July 2004 to June 2005, and had at least one inpatient or at least two outpatient claims coded for COPD. As a surrogate for severity of illness, COPD patients were stratified by complexity of illness using predefined International Classification of Diseases, Ninth Revision, Clinical Modification, Current Procedural Terminology, Fourth Edition, and Healthcare Common Procedure Coding System codes.

Results: A total of 42,565 patients with commercial insurance and 8507 Medicare patients were identified. Their mean age was 54.7 years and 74.8 years, and 48.7% and 46.9% were male, respectively. In total, 66.3% of commercial patients (n = 28,206) were not prescribed any maintenance COPD pharmacotherapy (59.1% no medication; 7.2% inhaled short-acting β2-agonist only). In the Medicare population, 70.9% (n = 6031) were not prescribed any maintenance COPD pharmacotherapy (66.0% no medication; 4.9% short-acting β2-agonist only). A subset of patients classified as high-complexity were similarly undertreated, with 58.7% (5358/9121) of commercial and 68.8% (1616/2350) of Medicare patients not prescribed maintenance COPD pharmacotherapy. Only 18.0% and 9.8% of diagnosed smokers in the commercial and Medicare cohorts had a claim for a smoking cessation intervention and just 16.6% and 23.5%, respectively, had claims for an influenza vaccination.

Conclusion: This study highlights a high degree of undertreatment of COPD in both commercial and Medicare patients, with most patients receiving no maintenance pharmacotherapy or influenza vaccination.

Keywords: chronic obstructive pulmonary disease; health care utilization; managed care; quality of care.

Figure 1

Flow of patients through the study. Complexity is used as a surrogate for COPD disease severity, and methodology for classification is described in full elsewhere. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2

Respiratory medication patterns in COPD patients^a. (A) Commercial (n = 42,565) and (B) Medicare (n = 8507). Notes: ^aIndividual medication groups are mutually exclusive. “Other combinations” includes: theophylline (methylxanthine bronchodilator) alone; short-acting anticholinergic plus theophylline; anticholinergic (short-acting or long-acting) plus theophylline plus inhaled corticosteroid; LABA; long-acting anticholinergic plus inhaled corticosteroid; SAAC; short-acting anticholinergic plus LABA; LABA plus theophylline plus inhaled corticosteroid. Abbreviations: Ach, anticholinergics; ICS, inhaled corticosteroid; LAAC, long-acting anticholinergic; LABA, long-acting β2-agonist inhaled bronchodilator; SAAC, short-acting anticholinergic; SABA, short-acting β2-agonist bronchodilator.