Predicting the costs of managing patients with chronic obstructive pulmonary disease

Abstract

The economic consequences of chronic obstructive pulmonary disease (COPD) are considerable, although the factors that best predict costs are largely unknown. This study used a population-based cohort to identify the clinical factors during an index year that were most predictive of increased direct medical costs in the subsequent year, and to develop a predictive model that described the cost variations in COPD. The medical records of 2116 patients enrolled in one regional health system who had COPD and health-care resource utilisation data for 1998 and 1999, were abstracted for information about symptoms, smoking history, chronic illnesses, and pulmonary function data. All inpatient, outpatient and pharmacy utilisation data for each subject for 1999 were extracted from the database. Total costs for each individual were transformed to a log scale. Potential causes of cost variability (predictor variables) were defined and classified into sets (or domains). Multiple linear regression models were fitted for each domain. The study demonstrated that severity of airflow obstruction, as assessed by FEV(1)% predicted, is a significant but weak predictor of future health-care resource utilisation-prior hospitalisation and home oxygen use, the presence of comorbid conditions and symptoms of dyspnoea are better predictors of costs. Those interested in the economic benefits of new COPD treatments and disease management programs need to carefully account for these factors.

Factors affecting chronic obstructive pulmonary disease (COPD)-related costs: a multivariate analysis of a Swedish COPD cohort

“…Mapel et al (27) Multiple analysis of factors most predictive of future direct medical costs in COPD, 2116 subjects…”

An Algorithm for the Identification of Undiagnosed COPD Cases Using Administrative Claims Data

“…We have examined the validity of these codes and this system for identifying COPD by medical record abstraction in previous projects and found them to be accurate, with more than 95% of these patients having documented clinical evidence to support the diagnosis. 18 For inclusion in the algorithm development group, we also required that COPD patients had received their first COPD diagnosis (index diagnosis) between 1997 and 2001. To be considered a new diagnosis, there could be no diagnosis codes for COPD appearing prior to the index diagnosis dating back to the patient' s initial membership in the health plan, or as of January 1, 1990.…”

“…14,15 We have shown in our previous studies that COPD patients have a higher risk of having comorbid conditions such as heart disease and that they also have substantially increased health care costs related to these diseases. [16][17][18] If patterns of health care utilization characteristic of undiagnosed COPD can be identified, then it is possible that the information found in administrative data, such as demographic information, health care claims, and pharmacy records, could be used as an efficient means of identifying persons at risk.…”

Patient Heterogeneity in Health Economic Decision Models for Chronic Obstructive Pulmonary Disease: Are Current Models Suitable to Evaluate Personalized Medicine?

“…Three models specified COPD-related costs by age. Several studies investigated the association between age and COPD-related costs and found no significant impact of age on costs [43][44][45][46]. This may be because age and FEV1% predicted are correlated and in three of these studies FEV1% was also included in the multivariate model and found to be a significant predictor.…”

“…Mortality in COPD is associated with age and FEV1, but also with co-morbidities, BMI, dyspnea and several other clinical parameters [32,34,36,38,53]. BMI also seems to be associated with quality of life in COPD [39,54] and co-morbidities may affect COPD-related costs [44,45,55,56]. Only the more recently developed models of Asukai (simulation) and Briggs included these types of clinical parameters and are therefore more suitable to evaluate personalized treatment that the other models .…”