Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

Abstract

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are at increased risk for lung infections and other pathologies (eg, pneumonia); however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia.MethodsA retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index), and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits), and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching.ResultsIn the baseline cohort (N=467,578), patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years) and had higher Charlson Comorbidity Index scores (3.3 vs 2.6) than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely to have a hospitalization (odds ratio; 95% confidence intervals [CI] =9.2; 8.9, 9.4) and four times more likely to have an ER visit (odds ratio; 95% CI =4.4; 4.3, 4.5) over the 12-month follow-up period compared to the control cohort. The estimated 12-month mean hospitalization costs ($14,353 [95% CI: $14,037–$14,690]), outpatient costs ($6,891 [95% CI: $6,706–$7,070]), and prescription drug costs ($1,104 [95% CI: $1,054–$1,142]) were higher in the pneumonia cohort than in the control cohort.ConclusionThis study demonstrated elevated health care resource use and costs in patients with COPD after acquiring pneumonia compared to those without pneumonia.

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

“…Pneumonia was found to be associated with both direct and indirect costs. Some studies have demonstrated that pneumonia increases total direct costs by 1.9–2.5 times for outpatients and by 3.39–4.72 times for hospitalized patients 15,32. In this study, costs were 1.6 times higher in patients with pneumonia compared to those without pneumonia.…”

Excess Costs of Comorbidities in Chronic Obstructive Pulmonary Disease: A Systematic Review

“…Most studies incorporate outcomes via comorbidity-specific assessment, only three incorporate outcomes based on binary presence or sole number of comorbidities [ 50 , 52 ] or odds ratios (OR) for being in the upper 25, “most costly”, patient percentile [ 53 ]. The sample size differs significantly among studies and reaches from 99 patients with COPD and anemia [ 49 ] to 84,130 patients each for a group of COPD patients with or without pneumonia [ 45 ]. Five studies [ 44 , 46 , 48 – 50 ] used routine data located entirely or partly in the Medicare and Medicaid environment; the rest utilized routine or survey data from other sources.…”

“…Five studies [ 44 , 46 , 48 – 50 ] used routine data located entirely or partly in the Medicare and Medicaid environment; the rest utilized routine or survey data from other sources. To control for differences between groups with and without comorbidity, three studies focused on pneumonia as comorbid disease [ 45 , 47 , 48 ], two studies focused on cardiovascular disease (CVD) [ 43 , 54 ], one on anemia [ 44 ], one on sleep apnea syndrome [ 49 ] and two on multiple comorbidities [ 46 , 51 ]. The rest focused on index-based outcomes.…”

Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans

“…37 The VACS-VC identifies all individuals at the time of the first ICD-9 diagnosis of HIV within the VA; once engaged in care, published data from 2008 support that 80% of HIV-infected Veterans are prescribed ART, only 14% have CD4+ <200 cells/μL, and 86% of eligible patients receive PCP prophylaxis. 38 Additionally, influenza and pneumococcal vaccination rates increase, likely also reflecting better engagement in and greater utilization of healthcare. 38 In our analyses, baseline CD4+ cell count remained significantly associated with CAP, TB and PCP risk.…”

“…38 Additionally, influenza and pneumococcal vaccination rates increase, likely also reflecting better engagement in and greater utilization of healthcare. 38 In our analyses, baseline CD4+ cell count remained significantly associated with CAP, TB and PCP risk. We also compared CD4+ prior to hospitalization and found no significant difference between those with and without COPD, suggesting that the association of COPD with risk for these pulmonary infections is less likely to be explained by differences in CD4+ cell count.…”