Investigating New Standards for Prophylaxis in Reduction of Exacerbations—The INSPIRE Study Methodology

Seemungal, Terence; Stockley, Robert A.; Calverley, Peter M.A.; Hagan, Gerry; Wedzicha, Jadwiga A.

doi:10.1080/15412550701407862

Cited by 24 publications

(9 citation statements)

References 41 publications

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“…Because ICU stays and hospitalizations for patients with COPD can often be the result of exacerbations, reducing the frequency of severe exacerbations could help to control COPD-related costs. Treatments that reduce the frequency of COPD-related hospitalizations or exacerbations11 are also associated with lower COPD-related medical costs, and in some cases lower total COPD-related costs 30,31. Additional research is needed to investigate the interrelationships among treatment for COPD, risk of exacerbation and hospitalization, and costs.…”

Section: Discussionmentioning

confidence: 99%

“…Maintenance medications, including bronchodilators, inhaled corticosteroids, combination medications, and oxygen therapy for severe COPD are primarily used at home. Hospitalization is common for patients experiencing a severe exacerbation 5,10,11. Severe exacerbations might be managed in an inpatient or emergency department (ED) setting, but life-threatening exacerbations may require immediate intensive care unit (ICU) admission 5…”

Section: Introductionmentioning

confidence: 99%

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Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009

Dalal¹,

Liu²,

Riedel³

2011

COPD

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BackgroundFew estimates of health care costs related to chronic obstructive pulmonary disease (COPD) are available regarding commercially insured patients in the United States. The aims of this retrospective observational analysis of administrative data were to describe and compare health care resource use and costs related to COPD in the United States for patients with commercial insurance or Medicare Advantage with Part D benefits, and to assess cost trends over time.MethodsPatient-level and visit-level health care costs in the calendar years 2006, 2007, 2008, and 2009 were assessed for patients with evidence of COPD. Generalized linear models adjusting for sex, age category, and geographic region were used to investigate cost trends over time for patients with Medicare or commercial insurance.ResultsMedical costs, which ranged from an annual mean of US$2382 (Medicare 2007) to US$3339 (commercial 2009) per patient, comprised the majority of total costs in all years for patients with either type of insurance. COPD-related costs were less for Medicare than commercial cohorts. In the multivariate analysis, total costs increased by approximately 6% per year for commercial insurance patients (cost ratio 1.06; 95% confidence interval [CI] 1.04–1.07; P < 0.001) and 5% per year for Medicare patients (cost ratio 1.05; 95% CI 1.03–1.07; P < 0.001). Costs for outpatient and emergency department visits increased significantly over time in both populations. Standard admission costs increased significantly for Medicare patients (cost ratio 1.03; 95% CI 1.00–1.05; P = 0.03), but not commercial patients, and costs for intensive care unit visits remained stable for both populations.ConclusionCOPD imposed a substantial economic burden on patients and the health care system, with costs increasing significantly in both the Medicare and commercial populations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009

Dalal¹,

Liu²,

Riedel³

2011

COPD

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“…ICU care was defined as a medical claim during an inpatient stay with revenue code of 020x, 021x, 0223 or 0234 or a current procedural terminology procedure code for critical care (99291–99292). These cohort definitions reflect COPD health care encounters associated with regular follow-up and exacerbations of increasing severity 1,11,13…”

Section: Methodsmentioning

confidence: 99%

Direct costs of chronic obstructive pulmonary disease among managed care patients

Dalal

Christensen²,

Liu³

et al. 2010

COPD

111

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PurposeTo estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD) among commercially insured patients in the US.MethodsIn this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days), emergency department (ED), standard inpatient admission, and intensive care unit (ICU) cohorts. Patient- level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated.ResultsOf the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD) annual COPD-related health care costs (2008 US$) increased across the cohorts (P < 0.001), ranging from $2003 ($3238) to $43,461 ($76,159) per patient. Medical costs comprised 96% of health care costs for the ICU cohort. Adjusted mean (SD) episode-level costs were $305 ($310) for an outpatient visit, $274 ($336) for an urgent outpatient visit, $327 ($65) for an ED visit, $9745 ($2968) for a standard admission, and $33,440 for an ICU stay.ConclusionDirect costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs.

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“…This question has now been answered by the INSPIRE Study which is the first long-term study of COPD exacerbations to compare the two types of exacerbations using the so-called symptom-based definition as well as the treatment-based definition 47,51. The results of the INSPIRE study show that if a symptom-based definition is used exclusively then the exacerbation rate detected is 3 per year but if a treatment-based definition is used then the rate detected is approximately 50% of this or about 1.5 exacerbations per year.…”

Section: Exacerbation Ratesmentioning

confidence: 99%

“…The largest comparative study so far published is the 2-year INSPIRE study47,51 which involved 1323 patients randomized to SFC or tiotropium with FEV 1 of 39%. The study showed the rate of treated exacerbations, the primary outcome measure, was about 1.30 in both arms and the rate of all exacerbations whether treated or not was about 3.0 in both arms.…”

Section: Interventionsmentioning

confidence: 99%

Exacerbation rate, health status and mortality in COPD – a review of potential interventions

Seemungal

Hurst²,

Wedzicha³

2009

COPD

Self Cite

182

129

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COPD is prevalent in Western society and its incidence is rising in the developing world. Acute exacerbations of COPD, about 50% of which are unreported, lead to deterioration in quality of life and contribute significantly to disease burden. Quality of life deteriorates with time; thus, most of the health burden occurs in more severe disease. COPD severity and frequent and more severe exacerbations are all related to an increased risk of mortality. Inhaled corticosteroids (ICS) have similar effects on quality of life but ICS/long-acting bronchodilator combinations and the long-acting antimuscarinic tiotropium all improve health status and exacerbation rates and are likely to have an effect on mortality but perhaps only with prolonged use. Erythromycin has been shown to decrease the rate of COPD exacerbations. Pulmonary rehabilitation and regular physical activity are indicated in all severities of COPD and improve quality of life. Noninvasive ventilation is associated with improved quality of life. Long-term oxygen therapy improves mortality but only in hypoxic COPD patients. The choice of an inhaler device is a key component of COPD therapy and this requires more attention from physicians than perhaps we are aware of. Disease management programs, characterized as they are by patient centeredness, improve quality of life and decrease hospitalization rates. Most outcomes in COPD can be modified by interventions and these are well tolerated and have acceptable safety profiles.

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Investigating New Standards for Prophylaxis in Reduction of Exacerbations—The INSPIRE Study Methodology

Cited by 24 publications

References 41 publications

Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009

Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009

Direct costs of chronic obstructive pulmonary disease among managed care patients

Exacerbation rate, health status and mortality in COPD – a review of potential interventions

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Investigating New Standards for Prophylaxis in Reduction of Exacerbations—The INSPIRE Study Methodology

Cited by 24 publications

References 41 publications

Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009

Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009

Direct costs of chronic obstructive pulmonary disease among managed care patients

Exacerbation rate, health status and mortality in COPD &ndash; a review of potential interventions

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Product

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Exacerbation rate, health status and mortality in COPD – a review of potential interventions