Anemia has been reported in 13-30% of patients diagnosed with COPD1,2,3. However, little information is available on the incremental economic burden resulting from concomitant anemia. We evaluated the impact of anemia on HRU and costs among COPD patients.
Retrospective data analysis of the Medicare 5% beneficiary encrypted files (BEF) was performed. All individuals with a COPD diagnosis code in the 1997-2001 BEF data were identified. COPD patients with anemia (A+) were identified using ICD-9 diagnosis codes or receipt of transfusion(s) in the absence of major GI bleeding, trauma, or surgery. A 6-month control period preceding the 1st COPD diagnosis (index date) served to compare disease severity.
Of the 132,424 patients with COPD identified, 27,932 (21%) had an anemia code. A+ patients were more likely to be older, female and non-Caucasian (p<0.0001). Except for pre-dialysis chronic kidney disease (22% A+ vs. 9% without anemia [A-], p<0.0001), comorbidity burden was similar between the 2 groups. Average total annual Medicare reimbursement was $855 for A+ and $437 for A- before the index date; after the index date it increased by 71% to $1466 in the A+ group vs. 49% to $649 in the A- group. In both groups, the greatest cost driver before and after the index date was hospitalizations, accounting for >50% of the average payments. In regression models controlling for demographics, disease severity, and comorbidities, anemia maintained an independent and significant association with increased payments.
Presence of anemia is associated with a substantial increase in resource utilization and costs among Medicare enrollees with COPD, independent of demographic differences, higher disease severity, and comorbidity burden.
Prospective studies are needed to evaluate the effect of anemia correction on HRU in the COPD population.1John M, et al. Chest. 2005;127:825-829.2Cote C, et al. Anemia Is Associated with Increased Breathlessness and Decreased 6-Minute Walk Distance in COPD Patients. Proc Am Thorac Soc 2005;2:A498.3Cote C, et al. Anemia Is a Predictor of Mortality in Patients with COPD. Proc Am Thorac Soc 2005;2:A890.
Michael Halpern, Grant monies (from industry related sources) Supported by a grant from Ortho Biotech Clinical Affairs, LLC.; Employee Marya Zilberberg, MD is an employee of Ortho Biotech Clinical Affairs, LLC.