FROM CHEST

The cost burden of chronic obstructive pulmonary disease increased significantly between 2000 and 2010 in British Columbia, according to results from a Canadian cohort study.

Hospitalization – and the fact that more COPD patients were diagnosed in the hospital rather than in community settings – appeared to be the primary driver of excess costs in COPD patients, which were about $5,452 more per patient-year than for a matched comparison cohort of people without COPD. (Note: All dollar amounts are in Canadian dollars, which were valued at 95% of the U.S. dollar in 2010).

Excess costs related to COPD increased by $296 per person year (P less than .01) over the course of the study, with hospital costs accounting for the great majority, increasing by $258 per person-year (P less than .01).

Inpatient costs accounted for more than half (57%) of total excess COPD-related costs recorded, with more than 40% of people in the COPD cohort diagnosed after hospital admission.

The study authors, led by Amir Khakban, M.Sc, of the University of British Colombia in Vancouver, suggested that low rates of spirometry use and limited awareness of COPD among community practitioners were the key factors leading to more hospitalizations over the course of a decade, and consequently to higher costs.

For their research, published in the September issue of CHEST ( 2015;148[3]:640-46 ), Mr. Khakban and colleagues used health care billing records from 153,570 COPD patients in British Columbia along with 246,801 age- and sex-matched controls identified in the same government database. Mean age at entry was 66.9 years for both cohorts, and slightly under half of the patients were women.

COPD is a known contributor to high medical costs, due to disease exacerbations that require hospitalization, and has long been recognized in Canada and elsewhere as a leading cause of hospitalization ( Respir Med. 2003;97[suppl C]:S23-S31 ). However, Mr. Khakban and colleagues’ study showed a rapid cost increase over a 10-year period, with costs 38% higher in 2010 than in 2001.

Compared with hospital-related costs (at 57%), outpatient, medication, and community care costs accounted for 16%, 22%, and 5%, respectively, of the excess costs seen among COPD patients in the study.

“Despite improvements, current disease management and care standards seem to be far from optimal and are not likely making any major impact,” the investigators wrote in their analysis. “This is especially evident in the high and growing rate of hospitalization as a major determinant of the burden of COPD.”

Mr. Khakban and colleagues noted that their findings likely represent an underestimate of the true cost burden of COPD, as reliance on narrow definitions from medical billing records means many cases were likely to have been missed. Also, they noted, the database used did not capture information on lung function or smoking, so costs could not be further analyzed according to disease severity or smoking status.

“In addition, not all components of direct costs are captured in the administrative health data. For example, costs of nonprescription medication or devices, and costs of complementary and alternative care are not captured in our results.”

The study was funded by the Institute for Heart + Lung Health, Genome Canada, St. Paul’s Hospital Foundation, PROOF Centre, the National Sanitarium Association, and the Canadian Respiratory Research Network. One coauthor, Carlo Marra, Pharm.D., disclosed financial relationships with GlaxoSmithKline, Pfizer and Abbvie.

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