Utilization and Medical Care Expenditures in Patients with Chronic Obstructive Pulmonary Disease: A Managed Care Claims Data Analysis
Kristina S. Yu-Isenberg
Eunice Y. Chang
Objective: To estimate annual healthcare utilization and expenditures for patients with chronic obstructive pulmonary disease (COPD) versus those without COPD, and to determine the attributable costs of treating the complications of COPD. Methods: This was a retrospective case-control study comparing 1-year (2000) utilization and expenditures for medical and pharmacy care between 18_061 COPD patients and 18_061 age-, sex-, and geographically matched control patients without COPD. Total medical expenditures were calculated using the actual amounts requested by the submitting provider. Total pharmacy expenditures were the charge for each prescription medication to the health plan. Results: Healthcare utilization, in terms of hospitalizations, emergency room admissions, and outpatient encounters, were two to three times higher in the patients with COPD than the control patients. Per person total healthcare expenditures for patients with COPD were 25 times (respiratory-related) and 1.6 times (nonrespiratory) greater than those for the matched control patients. Total expenditures were highest for patients with COPD who were 55-64 years of age. Conclusions: This claims analysis, utilizing data from a typical managed care population, demonstrates that COPD is a costly condition among managed care patients, as indicated by the high per person expenditures. Respiratory-related expenditures for patients with COPD were much higher, with acute hospitalizations accounting for a large proportion of the expenditures. Nonrespiratory-related expenditures were also higher among patients with COPD, reflecting expenditures associated with comorbid conditions. COPD exerts a large financial and nonfinancial burden on patients as well as the healthcare system. It is essential to educate primary care physicians about the impact of early diagnosis and treatment to improve lung function, clinical symptoms, and patient quality of life. As a result, interventions that decrease the likelihood of inpatient hospitalizations are likely to be cost effective from a managed care perspective.
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