Health status impairment and costs associated with COPD exacerbation managed in hospital

Abstract

Exacerbations of chronic obstructive pulmonary disease (COPD) have serious health consequences for patients and are strongly associated with unscheduled healthcare resource use. This study used a preference-based quality of life measure questionnaire (EQ-5D) to evaluate the impact of exacerbation on health status and utility during a patient's admission to hospital and short-term follow-up. Costs of admission were calculated. In total, 149 patients consented to take part in the study representing 222 admissions to hospital. At admission patients reported high levels of problems for all dimensions of the EQ-5D. Mean utility (-0.077) and Visual Analogue Scale (25.9) values indicated great impairment, with 61% of patients having a negative utility value representing a health state equivalent to 'worse than death' at admission. Many problems were still reported at discharge. By 3 months follow-up patients had deteriorated, with percentages of patients reporting problems in mobility (98%) and usual activity (88%) almost back up to admission levels. Health status and utility values were similar regardless of lung function at admission and at discharge. Approximately half of the patients in each category had a negative utility value at admission representing a health state 'worse than death', with similar levels of improvement by discharge. The mean cost of an admission was 2130.34 pounds (SD 1326.09) with only a mean of 110.37 pounds(5%) because of medication. No differences were noted by lung function category. In conclusion, all COPD patients requiring admission for an exacerbation suffer a serious deterioration in health status which, although improves during admission, notably deteriorates by 3 months postdischarge.

Quality of life and healthcare utilisation in cystic fibrosis: a multicentre study

“…There are limited data on EQ-5D decrements in utility for pulmonary exacerbations in other respiratory populations (in our investigation, data were only found in chronic obstructive pulmonary disease (COPD)). Both populations appear to experience a decrement in EQ-5D during a pulmonary exacerbation; however, the patients with CF in our study did not experience as great a decrease in EQ-5D as the COPD population [30]. In summary, the CFQ-R is likely to be most useful when exploring disease-specific components of HRQoL in CF; however, in conditions where it is important to make comparisons of HRQoL with other populations or when the aim is to calculate quality-adjusted life-years for cost-effectiveness analyses, researchers should consider using the EQ-5D.…”

A qualitative study of stakeholder views of a community-based anticipatory care service for patients with COPD

“…Four broad themes were identified: (1) the advantages and disadvantages of a CBACS for COPD; (2) what this service should cover and who should deliver it; (3) main design issues; and (4) training needs.…”

“…The largest cost associated with COPD is due to unplanned inpatient hospitalisation resulting from exacerbations, 1 which occur with all severities of COPD. 2 COPD exacerbations are a principal cause of the pressure on acute hospital beds in winter, 3 and have a negative impact on prognosis [4][5][6] and patient quality of life. 2 After smoking cessation, preventing exacerbations is the key factor in improving morbidity and mortality for COPD patients.…”

“…2 COPD exacerbations are a principal cause of the pressure on acute hospital beds in winter, 3 and have a negative impact on prognosis [4][5][6] and patient quality of life. 2 After smoking cessation, preventing exacerbations is the key factor in improving morbidity and mortality for COPD patients. 4,7 Thus, the development of an 'anticipatory care' service which prevents COPD exacerbationsand hence hospitalisation -could reduce pressure on secondary care services and improve patient outcomes, and enable patients to stay in their own home.…”

Avoiding hospital admission in COPD: impact of a specialist nursing team

“…It is the second highest cause of emergency admissions of any chronic disease in the UK (DH, 2010). Hospitalisation is responsible for up to 60% of the total cost of management for COPD patientsGuest, 1999;O'Reilly et al, 2007), and it is inevitable that these costs will continue to rise owing to the increasing number of people living with long-term conditions (DH, 2013). For the healthcare system, acute exacerbations of COPD are the most common cause of hospital admission, particularly in the winter, which places heightened pressure on demands for hospital beds (Ram et al, 2004).…”