Determinants of elevated healthcare utilization in patients with COPD

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system.MethodsThree-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL) indices were obtained using validated questionnaires among a subsample of 177 patients.ResultsHealthcare utilization was 3.4-fold higher among COPD patients compared with controls (p < 0.001). The "most-costly" upper 25% of COPD patients (n = 98) consumed 63% of all costs. Multivariate analysis revealed that independent determinants of being in the "most costly" group were (OR; 95% CI): age-adjusted Charlson Comorbidity Index (1.09; 1.01 - 1.2), history of: myocardial infarct (2.87; 1.5 - 5.5), congestive heart failure (3.52; 1.9 - 6.4), mild liver disease (3.83; 1.3 - 11.2) and diabetes (2.02; 1.1 - 3.6). Bivariate analysis revealed that cost increased as HRQoL declined and severity of airflow obstruction increased but these were not independent determinants in a multivariate analysis.ConclusionComorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

Health care charges for youth with newly diagnosed epilepsy

“…Although this relationship has not been examined previously in pediatric epilepsy, findings are consistent with pediatric 36 and adult studies 37,38 that demonstrate a direct impact of poor HRQOL on increased health care utilization. Poorer HRQOL predicted greater health care charges when charges related to behavioral medicine services were removed from the outcome variable, indicating that this relationship is not due to increased behavioral medicine service use.…”

The economic burden of chronic obstructive pulmonary disease in the elderly

“…productivity loss) were estimated in only two studies. Table 1 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] summarizes the details of the selected articles.…”

“…Otherwise, the effect of age on per episode costs is unclear, with several studies not detecting a significant cost difference between younger and older patients. In the study by Simon-Tuval et al [14], age was a significant determinant of high healthcare expenditure at bivariate level (i.e. belonging to the upper quartile of most costly patients; odds ratio¼1.03 per year þ1 increment; confidence interval 95%¼1.0-1.1; P¼0.001), but not in the multivariate analysis.…”

“…As COPD in elderly people is a strong risk factor for the development of concomitant disease conditions requiring hospitalization, excess inpatient costs should also be taken into account. Menzin et al [10], in their administrative claims analysis, showed that 55.7% of elderly COPD patients had at least one hospitalization for any reason compared with 14 Comparison of costs and resource use in the outpatient setting is complicated by the different definitions of outpatient services across the studies. In some studies, a detailed definition of outpatient service is missing.…”

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“…Patients with COPD experience episodes of acute worsening of respiratory symptoms termed exacerbations, often triggered by infections [1]. Frequent exacerbations are a stable feature of the disease [2] and have important impacts, such as, accelerating decline in lung function, reducing quality of life and impose higher health care utilization and costs [3][4][5]. Respiratory symptoms following an exacerbation can take a number of weeks to return to baseline [6].…”