Rising total costs and mortality rates associated with admissions due to COPD exacerbations

Molinari, Nicolas; Chanez, Pascal; Roche, N.; Ahmed, Engi; Vachier, Isabelle; Bourdin, Arnaud

doi:10.1186/s12931-016-0469-6

Cited by 30 publications

(25 citation statements)

References 26 publications

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“…Another important aspect is external validation using actual data from longitudinal or repeated surveys. In a recent manuscript, Molinari et al used data from hospital coding databases in France and reported increased rates of hospitalization and related-mortality [ 20 ]. Altogether, all models and surveys converge with our present study in demonstrating a high likelihood of further increase in COPD burden at a population level [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

An attempt at modeling COPD epidemiological trends in France

et al. 2018

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BackgroundAnticipating the future burden of chronic obstructive pulmonary disease (COPD) is required to develop adequate public health policies.MethodsA dynamic population model was built to estimate COPD prevalence by 2025 using data collected during the most recent large general population study on COPD prevalence in France (2005) as baseline values. Sensitivity analyses were performed to test the effect of variations in key input variables.ResultsThe model predicted a steady increase in crude COPD prevalence among subjects aged≥45 years from 2005 (prevalence estimate: 84.51‰) to 2025 (projected prevalence: 95.76‰, + 0.56‰/yr). There was a 4-fold increase in the prevalence of GOLD grade 3–4 cases, a 23% relative increase in women and a 21% relative increase in subjects ≥75 years. In sensitivity analyses, these temporal trends were robust. Factors associated with > 5% relative variations in projected 2025 prevalence estimates were baseline prevalence and severity distribution, incidence in women and severity of incident cases, transition rates between severity grades, and mortality.ConclusionsProjections of future COPD epidemiology consistently predict an increase in the prevalence of moderate-to-very severe COPD, especially due to increases among women and subjects aged ≥75 years. Developing robust prediction models requires collecting reliable data on current COPD epidemiology.Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0827-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

An attempt at modeling COPD epidemiological trends in France

et al. 2018

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“…41 A recent retrospective survey of hospitalisation costs of COPD since 2007 has indicated that both the number of these hospitalisations and their cost have risen over this period. 42 The advantage of the decision tree approach used in this study is that it allows relationships between variables to be identified in large data sets without a priori hypotheses and using all available data, and that the patient profiles identified are easily to apprehend. The principal limitations are that the quality of the output is dependent on the quality and pertinence of the input variables.…”

Section: Iteraɵonmentioning

confidence: 99%

<p>Identification of Patient Profiles with High Risk of Hospital Re-Admissions for Acute COPD Exacerbations (AECOPD) in France Using a Machine Learning Model</p>

Cavaillès¹,

Melloni²,

Motola³

et al. 2020

COPD

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Purpose: To characterise patients with chronic obstructive pulmonary disease (COPD) who are rehospitalised for an acute exacerbation, to estimate the cost of these hospitalisations, to characterise high risk patient sub groups and to identify factors potentially associated with the risk of rehospitalisation. Patients and Methods: This was a retrospective study using the French National Hospital Discharge Database. All patients aged ≥40 years hospitalised for an acute exacerbation of COPD between 2015 and 2016 were identified and followed for six months. Patients with at least one rehospitalisation for acute exacerbation of COPD constituted the rehospitalisation analysis population. A machine learning model was built to study the factors associated with the risk of rehospitalisation using decision tree analysis. A direct cost analysis was performed from the perspective of national health insurance. Results: A total of 143,006 eligible patients were hospitalised for an acute exacerbation of COPD (AECOPD) in 2015-2016 (mean age: 74 years; 62.1% men). 25,090 (18.8%) were rehospitalised for another exacerbation within six months. In this study, 8.5% of patients died during or immediately following the index hospitalisation and 10.5% died during or immediately after rehospitalisation (p <0.001). The specific cost of these rehospitalisations was € 5304. The overall total cost per patient of all AECOPD-related stays was € 9623, being significantly higher in patients who were rehospitalised (€ 16,275) compared to those who were not (€ 8208). In decision tree analysis, the most important driver of rehospitalisation was hospitalisation in the previous two years (contributing 85% of the information). Conclusion: Rehospitalisations for acute exacerbations of COPD carry a high epidemiological and economic burden. Since hospitalisation for an acute exacerbation is the most important determinant of future rehospitalisations, management of COPD needs to focus on interventions aimed at decreasing the rehospitalisation risk of in order to lower the burden of disease.

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“…Severe exacerbation of asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) are common causes of intensive care unit (ICU) admission and mechanical ventilation (1,2). However, early, accessible ambulatory treatment may improve disease control among these patients, reducing the rate of downstream complications (3)(4)(5)(6)(7)(8).…”

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Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure

Admon¹,

Sjoding²,

Lyon

et al. 2019

Annals ATS

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Rationale: The Affordable Care Act's Medicaid expansion has led to increased access to chronic disease care among newly insured adults. Despite this, its effects on clinical outcomes, particularly for patients with asthma, chronic obstructive pulmonary disease, and heart failure, are uncertain. Objectives: To assess whether Medicaid expansion was associated with changes in mechanical ventilation rates among hospitalized patients with heart failure, asthma, and chronic obstructive pulmonary disease. Methods: Difference-indifferences analysis comparing discharge data from four states that expanded Medicaid in 2014 (Arizona, Iowa, New Jersey, and Washington) and three comparison states that did not (North Carolina, Nebraska, and Wisconsin) was performed. Models were adjusted for patient and hospital factors. Results: Mechanical ventilation rates at baseline were 7.2% in nonexpansion states and 8.8% in expansion states. Medicaid expansion was associated with a decline in mechanical ventilation rates at 20.2% per quarter (95% confidence interval [CI], 20.3% to 0.0%; P = 0.010). We did not observe a change in the rate of ICU admission (20.4% per quarter; 95% CI, 20.8% to 0.1%; P = 0.10) or in-hospital mortality (0.1% per quarter; 95% CI, 0.0% to 0.1%; P = 0.30). In a negative control among adults aged 65 years or older, changes in mechanical ventilation rates were similar, though the CIs crossed zero (20.1%; 95% CI, 20.2% to 0.0%; P = 0.08). Conclusions: Medicaid expansion may have been associated with a decline in mechanical ventilation rates among uninsured and Medicaid-covered patients admitted with heart failure, chronic obstructive pulmonary disease, and asthma.

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Rising total costs and mortality rates associated with admissions due to COPD exacerbations

Cited by 30 publications

References 26 publications

An attempt at modeling COPD epidemiological trends in France

An attempt at modeling COPD epidemiological trends in France

<p>Identification of Patient Profiles with High Risk of Hospital Re-Admissions for Acute COPD Exacerbations (AECOPD) in France Using a Machine Learning Model</p>

Medicaid Expansion and Mechanical Ventilation in Asthma, Chronic Obstructive Pulmonary Disease, and Heart Failure

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