Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET
Received 22 January 2019
Accepted for publication 30 May 2019
Published 5 July 2019 Volume 2019:14 Pages 1423—1439
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Danalyn Byng,*,1,2 Johanna I Lutter*,1, Margarethe E Wacker,1 Rudolf A Jörres,3 Xiaofei Liu,4 Stefan Karrasch3,5, Holger Schulz,5 Claus Vogelmeier,6 Rolf Holle1, On behalf of the COSYCONET Consortium
1Institute 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; 2Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), 81377 Munich, Germany; 3Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; 4Institute for Biostatistics, Hannover Medical School, 30625 Hannover, Germany; 5Institute 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; 6Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, 35043 Marburg, Germany
*These authors contributed equally to this work
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.
Keywords: direct costs, population-based, healthcare expenditures, outpatient costs, inpatient costs, change score
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