Cost and Quality Issues Related to the Management of COPD

Abstract

The United States health care system must meet many challenges to preserve a patient's ability to access health care that is both affordable and of the highest quality. The ability to access health care providers has changed dramatically in the past decade and public debate continues about issues related to access and cost. In this article, we will focus on cost and quality issues related to the care of patients with chronic obstructive pulmonary disease (COPD). These issues are dynamic and rapidly evolving. COPD is a chronic process that mainly results from long term exposure to cigarette smoke. Treatment for COPD requires large expenditures of money to address the many problems encountered as the disease progresses and dyspnea worsens. Reimbursement for treating patients with COPD has declined as the result of federal initiatives. Fortunately, the quality of care has been preserved through better application of medications, earlier detection and intervention, and smoking cessation efforts. In addition, patient education and self help programs, rehabilitation, surgical interventions, and the application of new technologies have been of value. Physician input has ushered in a new era for patients with COPD and the widespread use of these modalities is beginning to restore quality-of-life once thought to be irretrievable. Lung volume reduction surgery (LVRS) offers new promise by countering physiologic alterations that increase the work of breathing. This procedure alters the derangements of gas exchange and dead space that heightens dyspnea and promotes a sedentary lifestyle. Surgical intervention coupled with exercise-focused rehabilitation may provide yet another avenue for patients with advanced COPD to improve the quality-of-life. Each intervention entails cost. Limited data are currently available about cost and quality issues related to the diagnosis, treatment and long term management of COPD and are reviewed below. We also address chronic childhood respiratory diseases with respect to medical care costs and quality.

Survival on long‐term oxygen therapy in chronic airflow limitation: from evidence to outcomes in the routine clinical setting

“…Survival of FMC CAL patients on LTOT has not improved over the 22‐year follow‐up period despite the continual adjustment to respiratory care, such as the introduction of new long‐acting β‐2 adrenoceptor agonists for CAL in recent years 12 . A recent Cochrane review of regular long‐acting β‐2 adrenoceptor agonists for COPD concluded that these drugs produce only small improvements in FEV 1 13 .…”

Chronic Obstructive Pulmonary Disease

“…Prevalence estimates suggest that 16 million Americans have COPD: 14 million with chronic bronchitis and 2 million with emphysema. 6,7 Prevalence rates are 1-3% in women and 4-6% in men. 7 For adults older than 55 years, the range is 10-15%.…”

“…The age-adjusted mortality rate for COPD increased 47.3% from 1979 to 1993; men had a 17.1% increase in deaths/100,000 patients compared with a 126.1% increase for women during the same period. 6 This gender difference reflects increased smoking among women.…”

“…1,2 Epidemiologists concur that COPD statistics underestimate the problem' s magnitude. 6 Yearly costs associated with COPD total $32.1 billion: $18 billion in direct health care costs and $14.1 billion in indirect costs. 8 This disease is responsible for more than 10 million doctor visits/year (or 5% of all office visits) and accounts for more than 2 million hospitalizations annually (13% of all hospitalizations).…”

“…8 This disease is responsible for more than 10 million doctor visits/year (or 5% of all office visits) and accounts for more than 2 million hospitalizations annually (13% of all hospitalizations). 6,7 The impact of COPD on daily living and quality of life is severe. A survey by the American Lung Association found that patients with COPD reported that their disease limited their ability to work (51%), engage in normal physical activity (70%), perform household chores (56%), participate in social activities (53%), sleep (50%), and take part in family activities (46%).…”