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      Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population

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          Abstract

          Background

          Exacerbations of chronic obstructive pulmonary disease (COPD) lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients.

          Methods

          For this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40–89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx), and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics.

          Results

          The final study sample involved 8554 patients; mean age was 70.1 ± 8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars) for the overall population and $6381 for patients with two or more exacerbations. All-cause health care costs were $18,976 for the overall population and $23,901 for patients with history of two or more exacerbations. Severity of exacerbations, presence of cardiovascular disease, diabetes, and long-term oxygen use were associated with higher adjusted costs.

          Conclusions

          The results indicate that despite treatment with maintenance medications, COPD patients continue to have exacerbations resulting in higher costs. New medications and disease management interventions are warranted to reduce the severity and frequency of exacerbations and the related cost impact of the disease.

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          Author and article information

          Journal
          Int J Chron Obstruct Pulmon Dis
          Int J Chron Obstruct Pulmon Dis
          International Journal of COPD
          International Journal of Chronic Obstructive Pulmonary Disease
          Dove Medical Press
          1176-9106
          1178-2005
          2012
          2012
          01 November 2012
          : 7
          : 757-764
          Affiliations
          [1 ]Competitive Health Analytics, Louisville, KY, USA
          [2 ]Health Economics and Outcomes Research, Forest Research Institute, Jersey City, NJ, USA
          Author notes
          Correspondence: Margaret Pasquale, Competitive Health Analytics, 325 West Main Street, WFP6W, Louisville, KY 40202, USA, Tel 513 271 2567, Fax 513 830 9180, Email mpasquale@ 123456humana.com
          Article
          copd-7-757
          10.2147/COPD.S36997
          3496536
          23152680
          © 2012 Pasquale et al, publisher and licensee Dove Medical Press Ltd

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          Categories
          Original Research

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