Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis

Abstract

ObjectiveTo estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD) among elderly individuals with chronic obstructive pulmonary disease (COPD) and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder–Oaxaca linear decomposition technique.MethodsThis study utilized a cross-sectional, retrospective study design, using data from multiple years (2006–2009) of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder–Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD.ResultsAmong elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001]) expenditures than did those with COPD/no GERD. Ordinary least squares regression revealed that individuals with COPD/GERD had 36.3% (P<0.001) higher expenditures than did those with COPD/no GERD. Overall, 30.9% to 43.6% of the differences in average health care expenditures were explained by differences in predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors between the two groups. Need factors explained up to 41% of the differences in average health care expenditures between the two groups.ConclusionAmong elderly Medicare beneficiaries with COPD, the presence of GERD was associated with higher expenditures. Need factors primarily contributed to the differences in average health care expenditures, suggesting that the comanagement of chronic conditions may reduce excess health care expenditures associated with GERD.

Concomitant Medication Use and New-Onset Diabetes Among Medicaid Beneficiaries with Chronic Obstructive Pulmonary Disease

“…These diagnosis codes have been utilized in prior published research to identify COPD and to evaluate medical treatments and health care outcomes among individuals with COPD. [20][21][22][23] Indeed, the sensitivity and specificity of using ICD-9-CM codes to identify patients with COPD have been established. 24,25 A study conducted by Gershon et al reported that identifying COPD using 1 or more ambulatory claims and/or hospitalizations for COPD resulted in a sensitivity of 85.0% (95% CI: 77.0 to 91.0) and a specificity of 78.4% (95% CI: 73.6 to 82.7).…”

Chronic obstructive pulmonary disease comorbidities

“…The interest in this comorbidity has been growing, because of its consistent association with more frequent COPD exacerbations, higher costs [48], and decreased quality of life in different cross-sectional and longitudinal studies [49,50 & ,51]. There are many potential, and unproved, reasons for the association, including chronic microaspiration, transdiaphragmatic pressure changes, abnormal swallowing patterns, and esophageal motility [52].…”

Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management

“…163,165 Subsequently, the presence of GERD symptoms and doctor-diagnosed GERD have been associated with worse quality of life, 166,167 chronic bronchitis 167 symptoms, and higher health care expenditures in patients with COPD. 168 The most well-studied outcome has been the association of GERD with exacerbation risk and health care utilization, and was even the subject of a recent meta-analysis. 169 Four studies defining GERD based on either questionnaires or doctor diagnosis showed GERD to be associated with a significantly higher risk for COPD exacerbation.…”