Costs of COPD exacerbations in the emergency department and inpatient setting

• Published in: Respiratory medicine Vol. 105; no. 3; pp. 454 - 460
• Main Authors: Dalal, Anand A, Shah, Manan, D’Souza, Anna O, Rane, Pallavi
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2011; Elsevier Limited
• Subjects: Aged; Analysis of Variance; Burden of illness; Cost-Benefit Analysis; Cross-Sectional Studies; Disease Progression; Economics; Emergency medical care; Emergency medical services; Emergency Service, Hospital - economics; Emergency Service, Hospital - utilization; Female; Health Care Costs - statistics & numerical data; Hospitalization; Hospitalization - economics; Humans; Inpatients; Male; Mortality; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary/Respiratory; Quality of Life; Retrospective Studies; Severity of Illness Index; Tuberculosis; United States > US; Burden of illness; inhaled corticosteroid; Inpatients; SD; intravenous; ICD-9-CM; LABA; LRTI; intensive care unit; long-acting beta-agonist; Emergency medical services; ED; Economics; cardiovascular disease; Hospitalization; emergency department; IV; CVD; LOS; URTI; lower respiratory tract infection; ICS; length of stay; ICU; international classification of diseases, ninth revision, clinical modification; upper respiratory tract infection; COPD; chronic obstructive pulmonary disease; standard deviation
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2010.09.003

Summary Background Exacerbations of COPD contribute to lung function decline and reduced quality of life. Treatment of exacerbations in the hospital setting is costly, but information concerning the component cost drivers of this care is scarce. Our objective was to describe and characterize costs of COPD care in the hospital setting. Methods Administrative data from 602 hospitals were used to calculate 2008 costs for COPD-related emergency department (ED) visits, simple inpatient admissions and complex admissions (categorized as intubation/no intensive care, intensive care/no intubation, or intensive care/intubation) among COPD patients’ age ≥40 years. Inpatient mortality, length of stay (LOS), and readmission rates in 2005–2008 were also calculated. Results Mean 2008 costs were $647 (SD $445) for ED visits ( n  = 24,617), $7242 ($7987) for simple admissions ( n  = 42,734), and $20,757 ($41,370) for complex admissions ( n  = 4142). Intensive care/intubation admissions incurred the highest costs ($44,909 [SD, $80,351]; n  = 838). Complex admissions accounted for 5.8% of hospital-based COPD care in 2008, but 20.9% of costs. Mean LOS ranged from 4.5 days (SD 3.3) for simple admissions to 16.0 days (16.7) for intensive care/intubation admissions. Death occurred in 0.9% of simple admissions, 10.3% of all complex admissions, and 26.5–39.1% of admissions involving intubation. Readmission rates within 30–60 days for ED visits, simple admissions and complex admissions were 17.8%, 15.3% and 15.7%, respectively. From 2005 to 2008, trends in LOS were relatively flat; inflation-adjusted costs increased 4.0–5.9%. Conclusions Costs of hospital-based care for COPD are substantial. Admissions involving intubation or intensive care are associated with the highest costs, LOS, and mortality.