Comparison of the accuracy of classification models to estimate healthcare use and costs associated with COPD exacerbations in Saskatchewan, Canada: A retrospective cohort study

Abstract

Objective: COPD is a high-cost disease and results in frequent contacts with the healthcare system. The study objective was to compare the accuracy of classification models with different covariates for classifying COPD patients into cost groups.

Methods: Linked health administrative databases from Saskatchewan, Canada, were used to identify a cohort of newly diagnosed COPD patients (April 1, 2007 to March 31, 2011) and their episodes of healthcare encounters for disease exacerbations. Total costs of the first and follow-up episodes were computed and patients were categorized as persistently high cost, occasionally high cost, and persistently low cost based on cumulative cost distribution ranking using the 75th percentile cutoff for high-cost status. Classification accuracy was compared for seven multinomial logistic regression models containing socio-demographic characteristics (i.e., base model), and socio-demographic and prior healthcare use characteristics (i.e., comparator models).

Results: Of the 1182 patients identified, 8.5% were classified as persistently high cost, 26.1% as occasionally high cost, and the remainder as persistently low cost. The persistently high-cost and occasionally high-cost patients incurred 10 times ($12 449 vs $1263) and seven times ($9334 vs $1263) more costs in their first exacerbation episode than persistently low-cost patients, respectively. Classification accuracy was 0.67 for the base model, whereas the comparator model containing socio-demographic and number of prior hospital admissions had the highest accuracy (0.72).

Conclusions: Costs associated with COPD exacerbation episodes are substantial. Adding prior hospitalization to socio-demographic characteristics produced the highest improvements in classification accuracy. Accurate classification models are important for identifying potential healthcare cost management strategies.

Keywords: chronic obstructive; cost analysis; healthcare costs; logistic models; longitudinal studies; pulmonary disease.

FIGURE 1. Average health services utilization and episode durations by cost group. ED, emergency department; SCU, special care unit.