PURPOSE: To examine the burden of chronic obstructive pulmonary disease (COPD) in a population consisting of Medicare-Medicaid dual eligibles with COPD residing in long-term care (LTC) facilities.
METHODS: This was a retrospective observational study using the Thomson Medstat Medicaid database. This database contains medical, procedural, and prescription drug claims on over 13 million Medicaid enrollees from eight geographically-diverse states. It includes: inpatient services, inpatient admissions, outpatient services, and prescription drug claims, as well as information on long-term care and other medical care services. COPD patients were identified using ICD-9-CM diagnosis codes (491.xx, 492.xx, 496.xx). All-cause and COPD-related healthcare resource use and costs was assessed in the 12-month period following the index date (date of first identification of COPD treatment). Inpatient, outpatient, LTC, and pharmacy costs were measured in the post-index period.
RESULTS: There were 3,037 patients identified with COPD (mean age 78 years, 63% female, 82% white) in the base population. About 12% had asthma and 47% had CHF as major comorbidities (Charlson comorbidity score of 1.6). Of these, 6.2% suffered a COPD-related hospitalization, and 22.5% had at least one COPD-related emergency department visit. Mean annual total all-cause costs (SD) for these patients were $42,618 (27,462); of this amount, $6,435 (13,259), or 15.1% of total medical costs were COPD-related. Other COPD-related costs included $466 (3,393) for inpatient costs; $341 (1,793) for outpatient costs, and $5,629 (12,562) LTC costs. Average annual pharmacy costs for COPD patients in this population were $961 (962).
CONCLUSION: Results show high services utilization and costs among this frail, geriatric COPD population residing in LTC facilities. COPD-related costs are notable, given all patients received treatment for COPD. Both COPD-related and overall all-cause resource use and costs seem higher compared to other populations studied in literature. More studies are needed to examine this population further.
CLINICAL IMPLICATIONS: Few studies have examined COPD costs in older Medicare beneficiaries living in nursing homes or other LTC facilities. This study adds to sparse literature in this population.
DISCLOSURE: Anand Dalal, Employee Anand Dalal is currently employed by GlaxoSmithKline (GSK); Consultant fee, speaker bureau, advisory committee, etc. Chris Blanchette was a consultant at LRRI who received funding from GSK to complete this analysis. Analysis was done independently and without any direction from GSK. Linda Simoni-Wastila was also a consultant at University of Maryland who performed this analysis and designed the study.; No Product/Research Disclosure Information