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COPD exacerbation frequency and its association with health care resource utilization and costs

Authors Dhamane A, Moretz C, Zhou Y, Burslem K, Saverno K, Jain G, Renda A, Kaila S

Received 9 June 2015

Accepted for publication 13 October 2015

Published 3 December 2015 Volume 2015:10(1) Pages 2609—2618


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Amol D Dhamane,1 Chad Moretz,2 Yunping Zhou,2 Kate Burslem,1 Kim Saverno,2 Gagan Jain,1 Andrew Renda,3 Shuchita Kaila1

1Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA; 2Comprehensive Health Insights Inc., Louisville, KY, USA; 3Humana Inc., Louisville, KY, USA

Background: Chronic obstructive pulmonary disease (COPD) exacerbations account for a substantial proportion of COPD-related costs.
Objective: To describe COPD exacerbation patterns and assess the association between exacerbation frequency and health care resource utilization (HCRU) and costs in patients with COPD in a Medicare population.
Methods: A retrospective cohort study utilizing data from a large US national health plan was conducted including patients with a COPD diagnosis during January 1, 2007 to December 31, 2012, aged 40–89 years and continuously enrolled in a Medicare Advantage Prescription Drug plan. Exacerbation frequency, HCRU, and costs were assessed during a 24-month period following the first COPD diagnosis (follow-up period). Four cohorts were created based on exacerbation frequency (zero, one, two, and ≥three). HCRU and costs were compared among the four cohorts using chi-square tests and analysis of variance, respectively. A trend analysis was performed to assess the association between exacerbation frequency and costs using generalized linear models.
Results: Of the included 52,459 patients, 44.3% had at least one exacerbation; 26.3%, 9.5%, and 8.5% had one, two, and ≥three exacerbations in the 24-month follow-up period, respectively. HCRU was significantly different among cohorts (all P<0.001). In patients with zero, one, two, and ≥three exacerbations, the percentages of patients experiencing all-cause hospitalizations were 49.7%, 66.4%, 69.7%, and 77.8%, respectively, and those experiencing COPD-related hospitalizations were 0%, 40.4%, 48.1%, and 60.5%, respectively. Mean all-cause total costs (medical and pharmacy) were more than twofold greater in patients with ≥three exacerbations compared to patients with zero exacerbations ($27,133 vs $56,033; P<0.001), whereas a greater than sevenfold difference was observed in mean COPD-related total costs ($1,605 vs $12,257; P<0.001).
Conclusion: COPD patients frequently experience exacerbations. Increasing exacerbation frequency is associated with a multiplicative increase in all-cause and COPD-related costs. This underscores the importance of identifying COPD patients at risk of having frequent exacerbations for appropriate disease management.

Keywords: COPD, exacerbations, frequency, costs

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