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      International Journal of COPD (submit here)

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      Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET

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          Abstract

          Background

          In light of overall increasing healthcare expenditures, it is mandatory to study determinants of future costs in chronic diseases. This study reports the first longitudinal results on healthcare utilization and associated costs from the German chronic obstructive pulmonary disease (COPD) cohort COSYCONET.

          Material and methods

          Based on self-reported data of 1904 patients with COPD who attended the baseline and 18-month follow-up visits, direct costs were calculated for the 12 months preceding both examinations. Direct costs at follow-up were regressed on baseline disease severity and other co-variables to identify determinants of future costs. Change score models were developed to identify predictors of cost increases over 18 months. As possible predictors, models included GOLD grade, age, sex, education, smoking status, body mass index, comorbidity, years since COPD diagnosis, presence of symptoms, and exacerbation history.

          Results

          Inflation-adjusted mean annual direct costs increased by 5% (n.s., €6,739 to €7,091) between the two visits. Annual future costs were significantly higher in baseline GOLD grades 2, 3, and 4 (factors 1.24, 95%-confidence interval [1.07–1.43], 1.27 [1.09–1.48], 1.57 [1.27–1.93]). A history of moderate or severe exacerbations within 12 months, a comorbidity count >3, and the presence of dyspnea and underweight were significant predictors of cost increase (estimates ranging between + €887 and + €3,679, all p<0.05).

          Conclusions

          Higher GOLD grade, comorbidity burden, dyspnea and moderate or severe exacerbations were determinants of elevated future costs and cost increases in COPD. In addition we identified underweight as independent risk factor for an increase in direct healthcare costs over time.

          Most cited references20

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          Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations.

          The aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5-95 yrs. Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family. After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3-95 yrs for Caucasians (n=57,395), African-Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV(1)) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV(1)/FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed. Spirometric prediction equations for the 3-95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future.
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            [Calculation of standardised unit costs from a societal perspective for health economic evaluation].

            Due to demographic aging, economic evaluation of health care technologies for the elderly becomes more important. A standardised questionnaire to measure the health-related resource utilisation has been designed. The monetary valuation of the resource use documented by the questionnaire is a central step towards the determination of the corresponding costs. The aim of this paper is to provide unit costs for the resources in the questionnaire from a societal perspective.
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              Is Open Access

              The German COPD cohort COSYCONET: Aims, methods and descriptive analysis of the study population at baseline.

              The German COPD cohort study COSYCONET ("COPD and SYstemic consequences-COmorbidities NETwork") investigates the interaction of lung disease, comorbidities and systemic inflammation. Recruitment took place from 2010 to 2013 in 31 study centers. In addition to the baseline visit, follow-up visits are scheduled at 6, 18, 36 and 54 months after baseline. The study also comprises a biobank, image bank, and includes health economic data. Here we describe the study design of COSYCONET and present baseline data of our COPD cohort.
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                Author and article information

                Contributors
                On behalf of : On behalf of the COSYCONET Consortium
                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                05 July 2019
                2019
                : 14
                : 1423-1439
                Affiliations
                [1 ] Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, GmbH – German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research , 85764 Neuherberg, Germany
                [2 ] Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU) , 81377 Munich, Germany
                [3 ] Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich , 80336 Munich, Germany
                [4 ] Institute for Biostatistics, Hannover Medical School , 30625 Hannover, Germany
                [5 ] Institute of Epidemiology, Helmholtz Zentrum München (GmbH) – German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL) , 85764 Neuherberg, Germany
                [6 ] Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research , 35043 Marburg, Germany
                Author notes
                Correspondence: Johanna I Lutter Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health , Ingolstädter Landstraße 1, 85764Neuherberg, GermanyTel +49 8 931 874 9314 Email johanna.lutter@ 123456helmholtz-muenchen.de
                [*]

                These authors contributed equally to this work

                Article
                201899
                10.2147/COPD.S201899
                6616193
                31308648
                0098aa19-74b8-4d3a-9c48-6e78ce053550
                © 2019 Byng et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 22 January 2019
                : 30 May 2019
                Page count
                Tables: 6, References: 29, Pages: 17
                Categories
                Original Research

                Respiratory medicine
                direct costs,population-based,healthcare expenditures,outpatient costs,inpatient costs,change score

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