Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population

Abstract

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often have multiple underlying comorbidities, which may lead to increased health care resource utilization (HCRU) and costs.ObjectiveTo describe the comorbidity profiles of COPD patients and examine the associations between the presence of comorbidities and HCRU or health care costs.MethodsA retrospective cohort study utilizing data from a large US national health plan with a predominantly Medicare population was conducted. COPD patients aged 40–89 years and continuously enrolled for 12 months prior to and 24 months after the first COPD diagnosis during the period of January 01, 2009, through December 31, 2010, were selected. Eleven comorbidities of interest were identified 12 months prior through 12 months after COPD diagnosis. All-cause and COPD-related hospitalizations and costs were assessed 24 months after diagnosis, and the associations with comorbidities were determined using multivariate statistical models.ResultsNinety-two percent of 52,643 COPD patients identified had at least one of the 11 comorbidities. Congestive heart failure (CHF), coronary artery disease, and cerebrovascular disease (CVA) had the strongest associations with all-cause hospitalizations (mean ratio: 1.56, 1.32, and 1.30, respectively; P<0.0001); other comorbidities examined had moderate associations. CHF, anxiety, and sleep apnea had the strongest associations with COPD-related hospitalizations (mean ratio: 2.01, 1.32, and 1.21, respectively; P<0.0001); other comorbidities examined (except chronic kidney disease [CKD], obesity, and osteoarthritis) had moderate associations. All comorbidities assessed (except obesity and CKD) were associated with higher all-cause costs (mean ratio range: 1.07–1.54, P<0.0001). CHF, sleep apnea, anxiety, and osteoporosis were associated with higher COPD-related costs (mean ratio range: 1.08–1.67, P<0.0001), while CVA, CKD, obesity, osteoarthritis, and type 2 diabetes were associated with lower COPD-related costs.ConclusionThis study confirms that specific comorbidities among COPD patients add significant burden with higher HCRU and costs compared to patients without these comorbidities. Payers may use this information to develop tailored therapeutic interventions for improved management of patients with specific comorbidities.

Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China

“…This may be explained by the trade-off between outpatient and inpatient visits since hypertension, cardiovascular diseases and liver diseases were the three comorbidities with the largest increase of inpatient admission numbers. And the greater hospitalization for comorbid hypertension and cardiovascular diseases was also reported from prior research [19] on COPD patients. Nevertheless, given a limited explanation for this issue, further in-depth investigation is required to explore the causation.…”

“…For example, one study in Canada [18] suggested that use of all health services and medical cost was increased with comorbidity among older adults with stroke. An association between the presence of comorbidities and all-cause hospitalizations and health care costs was also reported among chronic obstructive pulmonary disease (COPD) patients [19]. Patients with more than one type of chronic diseases would naturally require more care and additional medical resources, and the impact of comorbidity on the treatment and performance of lung cancer patients has been demonstrated by a series of studies [20,21].…”

Biologics for Chronic Obstructive Pulmonary Disease: Present and Future

“…Smoking also causes hyperplasia of mucus-producing goblet cells, and metaplasia of basal cells and squamous epithelial cells 14,15 . Cigarette smoke is associated with the loss of airway epithelial tight junctions, which normally form an impermeable barrier protecting the respiratory tract from pathogens or harmful particles 8,11,12,15 . The number of neutrophils and macrophages in the lower airways is also increased for patients with COPD 7 , and the phagocytosis of apoptotic cells by macrophages is impaired 14 .…”

“…However, in addition to disease characteristics that vary between individual patients 6,7 , treatment for COPD is further complicated by the substantial comorbidity burden of this patient population. More than 90% of patients with COPD report having one or more comorbidities, and approximately 50% report having four or more 8 . Common comorbidities include hypertension and other cardiac diseases, metabolism disorders, diabetes mellitus, osteoporosis, muscle wasting, cancer, and depression.…”

“…These comorbidities can directly influence each other. For example, there is evidence that inflammation associated with COPD increases the risk of developing heart disease and lung cancer 8 . Therefore, the management of patients with COPD requires an integrated comprehensive care approach 9 .…”