title: The distribution of costs of care in mechanically ventilated patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To delineate the costs of care of patients with Chronic Obstructive Pulmonary Disease (COPD) and respiratory failure and to compare them with those of other mechanically ventilated patients.
  
  
  METHODS
  A post hoc analysis of a prospective investigation.
  
  
  METHODS
  Medical and coronary intensive care units (ICUs) of an 804-bed, university-based hospital.
  
  
  METHODS
  A total of 300 mechanically ventilated patients, 44 with COPD and 256 others, were included.
  
  
  RESULTS
  Despite similar lengths of ICU stay (9 days) and mechanical ventilation (5.5 days COPD vs. 5 days other, p = .11), ICU respiratory care costs for patients with COPD were $2,422 ($1,157-$6,110) [median U.S. dollars (interquartile range)] vs. $1,580 ($738-$3,322) for the others (p = .01). Ventilator costs for COPD patients were $1,795 ($943-$5,782) vs. $1,574 ($613-$3,112) (p = .12). Total hospitalization respiratory care costs for COPD patients were higher, $4,064 ($2,422-$9,572) vs. $2,342 ($1,186-$4,591), (p = .0001), and 74.4% of the median difference in cost between COPD patients and others was accounted for by spontaneous nebulizers (p = .001), metered dose inhalers (p = .01), and pulse oximetry (p = .02). By using multiple linear regression analyses, we found that COPD remained associated with higher respiratory costs (p<.05). Respiratory Care was the third largest category of hospital costs after beds (27%) and pharmacy expenses (25%), and it comprised approximately 14% of total cost. Total hospital costs were large for both groups, but did not differ between COPD and the others [$24,217 ($16,211-$58,834) vs. $27,672 ($15,692-$53,766), respectively (p = .96)]. Linear regression analyses showed that only Acute Lung Injury score was significantly related to total ICU and hospital costs of care (p<.05).
  
  
  CONCLUSIONS
  Costs of ICU and non-ICU respiratory care for patients with COPD are higher than costs of care for other mechanically ventilated patients. Although the increased cost of bronchodilators and oximetry in these patients may serve as target areas for reductions in respiratory care costs, it may also be true that these modalities of therapy and management are necessary and need to be used with even greater intensity to achieve better outcomes. The predominant contributions of bed and pharmacy costs in all of our patients with respiratory failure support research efforts addressing these aspects of care.
authors.affiliation: Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA. wes.ely@mcmail.vanderbilt.edu
authors.forename: E W
authors.initials: EW
authors.lastname: Ely
authors.forename: A M
authors.initials: AM
authors.lastname: Baker
authors.forename: G W
authors.initials: GW
authors.lastname: Evans
authors.forename: E F
authors.initials: EF
authors.lastname: Haponik
mesh_terms: D000368:Aged; D003363:Cost Control; D003422:Critical Care / Q000191:economics*; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008173:Lung Diseases, Obstructive / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000191:economics*; D012131:Respiratory Insufficiency / Q000191:economics / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis