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

• Published in: International journal of chronic obstructive pulmonary disease Vol. 12; pp. 735 - 744
• Main Authors: Schwab, Phil, Dhamane, Amol D, Hopson, Sari D, Moretz, Chad, Annavarapu, Srinivas, Burslem, Kate, Renda, Andrew, Kaila, Shuchita
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2017; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Adult; Aged; Aged, 80 and over; Anxiety; Arthritis; Cardiovascular disease; Care and treatment; Chronic illnesses; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Codes; comorbidities; Comorbidity; COPD; cost; Costs; Development and progression; Diabetes; Economic aspects; Female; Health aspects; Health Care Costs; Health care expenditures; Health care policy; Health Resources - economics; Health Resources - utilization; Health services utilization; Heart failure; Hospital Costs; Hospitalization; Hospitalization - economics; Humans; Hypertension; Linear Models; Male; Medicare; Medicare - economics; Middle Aged; Models, Economic; Multivariate Analysis; Obesity; Original Research; Osteoarthritis; Osteoporosis; Population; Process Assessment (Health Care) - economics; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - therapy; Retrospective Studies; Review boards; Sleep apnea; Time Factors; Treatment Outcome; Tuberculosis; United States - epidemiology; utilization; United States; United States > US; database; utilization; cost; Medicare; comorbidities; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S112256

Patients with chronic obstructive pulmonary disease (COPD) often have multiple underlying comorbidities, which may lead to increased health care resource utilization (HCRU) and costs.
To describe the comorbidity profiles of COPD patients and examine the associations between the presence of comorbidities and HCRU or health care costs.
A 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.
Ninety-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;
<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;
<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,
<0.0001). CHF, sleep apnea, anxiety, and osteoporosis were associated with higher COPD-related costs (mean ratio range: 1.08-1.67,
<0.0001), while CVA, CKD, obesity, osteoarthritis, and type 2 diabetes were associated with lower COPD-related costs.
This 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.