Exacerbation Rates and Costs of COPD in a Managed Care Population

Cincinnati—Chronic obstructive pulmonary disease (COPD), a progressive disease characterized by persistent airflow limitation, chronic and progressive dyspnea, cough, and sputum production, is often complicated by exacerbations. The exacerbations are associated with high mortality rates and poor long-term outcomes and may accelerate the progression of COPD.

The total annual cost of COPD in the United States is an estimated $49.9 billion, with $29.5 attributable to direct healthcare costs.

According to researchers, there have been few studies on the real-world rate and costs of COPD exacerbations among patients treated for chronic bronchitis (CB) with a history of exacerbations. The researchers recently conducted a study to estimate COPD exacerbation rates and related costs among a subpopulation of CB patients with prior-year exacerbations from a large managed care population. They reported study results during a poster session at the AMCP meeting. The poster was titled Exacerbation Rates and Costs in Treated Chronic Bronchitis Patients with a History of Exacerbation: A Managed Care Perspective.

The secondary objective of the study was to examine predictors of exacerbations and costs during follow-up as a function of prior-year exacerbation.

The retrospective study utilized data from the HealthCore Integrated Research Database from January 1, 2004, through May 31, 2011. The database includes medical and pharmacy administrative claims from approximately 45 million members from health plans across the United States.

Study outcomes were COPD exacerbations and COPD exacerbation-related costs. Exacerbations were categorized as severe (inpatient hospitalization with a primary diagnosis of COPD) or moderate (an emergency department visit with a primary diagnosis of COPD or a prescription for an oral corticosteroid filled within 7 days of an office visit related to COPD). COPD-related costs included all healthcare utilization costs occurring up to 14 days from the date of the qualifying exacerbation event.

Following application of inclusion and exclusion criteria, 4349 patients were included in the study. Mean age of study participants was 68.3 years and 52.7% were female. Of the total sample, 32.0% (n=1392) of patients had experienced >2 exacerbations during the baseline year.

During the study follow-up year, 36.0%, 34.0%, and 57.4% had ≥1 moderate, severe, or any exacerbation, respectively. Baseline exacerbation rate was a strong predictor of follow-up exacerbation rates (P<.001).

The mean exacerbation-related costs during the follow-up year were $241, $17,163, and $7374 per moderate, severe, or any exacerbation, respectively. Baseline year exacerbation rate was a strong predictor of follow-up exacerbation-related costs (P<.001).

Limitations to the study cited by the researchers included possible inaccuracy of database coding, not controlling for unmeasured patient or physician characteristics, and a lack of standard claims-based CB severity measures.

In conclusion, the researchers summarized their findings: despite treatment with COPD medications among these high-risk patients, exacerbations continued to occur and exacerbation rates and costs per exacerbation remained high during follow-up year. “Patients with prior exacerbation history have unmet needs and may require additional treatment strategies to reduce exacerbations and associated costs,” they added.

This study was supported by Forest Research Institute, Inc., a wholly owned subsidiary of Forest Laboratories, Inc.