<p>Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET</p>

Abstract

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.

Deterioration and Mortality Risk of COPD Patients Not Fitting into Standard GOLD Categories: Results of the COSYCONET Cohort

“…An interesting observation was that the disease burden seemed similar across grades as underlined by the fact that the amount of respiratory medication was also similar. This is further supported by a previous analysis, in which we found similar healthcare resource utilization and healthcare costs for patients with grades 0, 1, and 2 [23].…”

Economic Burden of COPD by Disease Severity – A Nationwide Cohort Study in Denmark

“…Generally, exacerbations seem to be the main cost driver in COPD and the economic burden of exacerbations in COPD has been documented in a number of studies. [9][10][11][12] Although, daily symptom burden is associated with increased risk of exacerbations and hospital admissions, the link between daily dyspnea symptoms and costs has not previously been explored in a longitudinal study. Furthermore, important cost information in an elderly population such as cost of elder care and retirement homes has rarely been described in studies as this information is often not available.…”

<p>CODEXS: A New Multidimensional Index to Better Predict Frequent COPD Exacerbators with Inclusion of Depression Score</p>

“…Acute exacerbation of COPD (AECOPD) is an event defined as acute worsening of respiratory symptoms that result in additional therapy. 1 It can accelerate deterioration of the disease, 2,3 lead to a heavy economic burden, 4 and increase mortality. 5 Recently, there is an increasing recognition that COPD is a complex and heterogeneous disease.…”