Chronic Obstructive Pulmonary Disease in a Managed-Care Setting
Objective: To identify patterns of care and associated costs for typical patients with chronic obstructive pulmonary disease (COPD) in a US managed-care setting. Design: Retrospective analysis of administrative data from a proprietary managed-care research database. Patients: 6371 patients with COPD. Methods: A `core' population of enrollees was identified who were continuously eligible for healthcare services (including prescription medications) for at least 12 months and who actively utilized services. From this core population, patients with two or more claims listing International Classification of Diseases, nineth edition, Clinical Modification diagnosis codes for COPD were selected as the COPD study population. The core and COPD study databases were then analyzed to quantify healthcare utilization and charges over the period from October 1995 through September 1996. Results: Approximately one-half of patients with COPD were in the 45- to 64-year age group. The average total healthcare charge for patients with COPD was $US1109 per month (1995/1996 values), compared with $US179 per month for the average patient with healthcare claims. Although only 19% of patients with COPD were hospitalized for COPD, 58% of COPD-attributed healthcare charges were for hospitalizations. Physician visits and tests accounted for another 23% of COPD-attributed healthcare charges, and medications for 9%. Over 25% of patients with COPD had an emergency room visit, compared with 10% of all patients with claims. 40% of patients with COPD received at least one prescription for a respiratory medication during the year. 15% received anticholinergic bronchodilators, 30% received beta2-agonist inhalers, 13% received xanthine bronchodilators, and 14% received inhaled corticosteroids. Patients with COPD had over twice as many medical conditions for which they sought healthcare compared with the average patient with claims. Conclusions: Although COPD has been viewed as a disease of the elderly, it also significantly affects the quality of life of the `not so elderly', and represents a significant cost exposure to commercial health plans in the US. Despite the availability of acceptable clinical guidelines, there are many opportunities to optimize healthcare utilization and the standard of care for patients with COPD, including ensuring that patients receive those medications considered to be first-line treatment for COPD.
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