Economic Burden of COPD in the Presence of Comorbidities

Abstract

Background: The morbidity and mortality associated with COPD exacts a considerable economic burden. Comorbidities in COPD are associated with poor health outcomes and increased costs. Our objective was to assess the impact of comorbidities on COPD-associated costs in a large administrative claims dataset.

Methods: This was a retrospective observational study of data from the Truven Health MarketScan Commercial Claims and Encounters and the MarketScan Medicare Supplemental Databases from January 1, 2009, to September 30, 2012. Resource consumption was measured from the index date (date of first occurrence of non-rule-out COPD diagnosis) to 360 days after the index date. Resource use (all-cause and disease-specific [ie, COPD- or asthma-related] ED visits, hospitalizations, office visits, other outpatient visits, and total length of hospital stay) and health-care costs (all-cause and disease-specific costs for ED visits, hospitalizations, office visits, and other outpatient visits and medical, prescription, and total health-care costs) were assessed. Generalized linear models were used to evaluate the impact of comorbidities on total health-care costs, adjusting for age, sex, geographic location, baseline health-care use, employment status, and index COPD medication.

Results: Among 183,681 patients with COPD, the most common comorbidities were cardiovascular disease (34.8%), diabetes (22.8%), asthma (14.7%), and anemia (14.2%). Most patients (52.8%) had one or two comorbidities of interest. The average all-cause total health-care costs from the index date to 360 days after the index date were highest for patients with chronic kidney disease ($41,288) and anemia ($38,870). The impact on total health-care costs was greatest for anemia ($10,762 more, on average, than a patient with COPD without anemia).

Conclusions: Our analysis demonstrated that high resource use and costs were associated with COPD and multiple comorbidities.

Figure 1 –

Patient selection. ICS = inhaled corticosteroid; LABA = long-acting β₂-adrenergic agonist; LAMA = long-acting muscarinic antagonist.

Figure 2 –

A, B, Resource use from index date through 360 d after the index date for each outcome. A, By comorbidity. B, By number of comorbidities. CKD = chronic kidney disease; CVD = cardiovascular disease; ER = emergency room.

Figure 3 –

Difference in average total health-care cost by comorbidity from index date through 360 d after the index date in 2012 US dollars. See Figure 2 legend for expansion of abbreviations.