Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) often have multiple underlying comorbidities, which may lead to increased health care resource utilization (HCRU) and costs.

Objective: To describe the comorbidity profiles of COPD patients and examine the associations between the presence of comorbidities and HCRU or health care costs.

Methods: A retrospective cohort study utilizing data from a large US national health plan with a predominantly Medicare population was conducted. COPD patients aged 40-89 years and continuously enrolled for 12 months prior to and 24 months after the first COPD diagnosis during the period of January 01, 2009, through December 31, 2010, were selected. Eleven comorbidities of interest were identified 12 months prior through 12 months after COPD diagnosis. All-cause and COPD-related hospitalizations and costs were assessed 24 months after diagnosis, and the associations with comorbidities were determined using multivariate statistical models.

Results: Ninety-two percent of 52,643 COPD patients identified had at least one of the 11 comorbidities. Congestive heart failure (CHF), coronary artery disease, and cerebrovascular disease (CVA) had the strongest associations with all-cause hospitalizations (mean ratio: 1.56, 1.32, and 1.30, respectively; P<0.0001); other comorbidities examined had moderate associations. CHF, anxiety, and sleep apnea had the strongest associations with COPD-related hospitalizations (mean ratio: 2.01, 1.32, and 1.21, respectively; P<0.0001); other comorbidities examined (except chronic kidney disease [CKD], obesity, and osteoarthritis) had moderate associations. All comorbidities assessed (except obesity and CKD) were associated with higher all-cause costs (mean ratio range: 1.07-1.54, P<0.0001). CHF, sleep apnea, anxiety, and osteoporosis were associated with higher COPD-related costs (mean ratio range: 1.08-1.67, P<0.0001), while CVA, CKD, obesity, osteoarthritis, and type 2 diabetes were associated with lower COPD-related costs.

Conclusion: This study confirms that specific comorbidities among COPD patients add significant burden with higher HCRU and costs compared to patients without these comorbidities. Payers may use this information to develop tailored therapeutic interventions for improved management of patients with specific comorbidities.

Keywords: COPD; Medicare; comorbidities; cost; database; utilization.

Figure 1

Study sample. Notes: ^aCOPD diagnosis: ≥2 medical claims occurring on separate dates within 90 days with a COPD diagnosis code (ICD-9-CM code 491.xx, 492.xx, or 496.xx) in the primary or secondary position. ^bIndex date: the date of first medical claim with a COPD diagnosis during the study identification period. ^cPreindex period: a 12-month period prior to index date. ^dPostindex period: a 24-month period after index date. ^e≥1 medical claim with any of the following ICD-9-CM diagnosis codes in any position: 277.0x (cystic fibrosis), 011.x (pulmonary tuberculosis), or 140.xx–172. xx, 174.xx–209.3x, and 209.7x (malignant neoplasms). Abbreviations: COPD, chronic obstructive pulmonary disease; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; MAPD, Medicare Advantage plan with Prescription Drug benefits.