COPD with GERD Associated with High Medicare Costs

Chronic obstructive pulmonary disease (COPD) is associated with annual direct costs of $29.5 billion. COPD exacerbations are the key drivers of the healthcare costs, accounting for approximately 70%. Comorbid chronic conditions among COPD patients may also be associated with frequent COPD exacerbations.

Gastroesophageal reflux disease (GERD) is a highly prevalent co-occurring condition among patients with COPD. A previous meta-analysis found that the presence of GERD is an independent and significant predictor of COPD exacerbations, and individuals with COPD and GERD had 7 times the risk of experiencing COPD exacerbations compared with patients with COPD but no GERD.

A recent study examined the estimated excess healthcare expenditures associated with GERD among older individuals with COPD [Int J Chron Obstruct Pulmon Dis. 2014;9:339-348]. This was a cross-sectional study with retrospective, observational data.

Data were collected from the Medicare Current Beneficiary Survey, a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and noninstitutionalized Medicare beneficiaries. Data from 2006 to 2009 were used.

The presence of COPD and GERD was identified using diagnoses codes. Healthcare costs examined included inpatient, outpatient, prescription drugs, dental, medical provider, and other services.

Patients >65 years of age with at least 1 inpatient visit or 2 outpatients visits with COPD codes were considered to be diagnosed with COPD and were included in the study. Additional study inclusion criteria were community-dwelling and fee-for-service Medicare beneficiaries with full year enrollment during the calendar year. A total of 2461 older Medicare beneficiaries were considered for the final study sample. Sources of payment included third-party payers, such as Medicare, Medicaid, Veterans Affairs Health Insurance, private health maintenance organizations, employer-sponsored insurance providers, individually purchased insurance providers, and others.

Of the study participants, 29.3% of the older Medicare beneficiaries with COPD had co-occurring GERD. No statistically significant differences in predisposing characteristics, enabling resources, personal healthcare practices, or external environment were observed between the group with COPD and GERD and the group with COPD without GERD.

Differences in need variables were statistically significant between the 2 groups, however. Older Medicare beneficiaries with COPD and GERD had higher rates of poorly perceived physical health compared to the COPD without GERD group (17.5% vs 12.2%, respectively; P<.001). Higher rates of depression (22% vs 12.3%, respectively; P<.001), anxiety (16.2% vs 9%, respectively; P<.001), and Charlson’s comorbidity index ≥5 score (35% vs 25%, respectively; P<.001) were seen in patients with COPD and GERD compared with patients with COPD without GERD.

The annual Medicare cost for patients with COPD without GERD was estimated at $24,722 per patient per year, while the annual Medicare cost for patients with COPD and GERD was $36,793 (P<.001), indicating that the inclusion of GERD with COPD resulted in 1.5 times the healthcare expenditures. Ordinary least squares regression indicated that individuals with COPD and GERD had 36.3% higher expenditures than patients with COPD without GERD (P<.001).

The study’s authors noted limitations, including lack of information on the severity and duration of COPD and GERD. Also, the study’s findings can only be generalized to community-dwelling, fee-for-service Medicare enrollees.

The authors noted that this is the first study to assess excess healthcare expenditures associated with COPD and GERD in the older Medicare population. The authors concluded that comprehensive and coordinated healthcare management of individuals with COPD and GERD may be necessary to reduce excess healthcare spending.