Health care utilization in chronic obstructive pulmonary disease. A case-control study in a health maintenance organization.
BACKGROUND
Information about health care utilization and costs among patients with chronic obstructive pulmonary disease (COPD) is needed to improve care and for appropriate allocation of resources for patients with COPD (COPD patients or cases) in managed care organizations.


METHODS
Analysis of all inpatient, outpatient, and pharmacy utilization of 1522 COPD patients continuously enrolled during 1997 in a 172,484-member health maintenance organization. Each COPD case was matched with 3 controls (n = 4566) by age (+/-5 years) and sex. Information on tobacco use and comorbidities was obtained by chart review of 200 patients from each group.


RESULTS
Patients with COPD were 2.3 times more likely to be admitted to the hospital at least once during the year, and those admitted had longer average lengths of stay (4.7 vs 3.9 days; P<.001). Mean costs per case and control were $5093 vs $2026 for inpatient services, $5042 vs $3050 for outpatient services, and $1545 vs $739 for outpatient pharmacy services, respectively (P<.001 for all differences). Patients with COPD had a longer smoking history (49.5 vs 34.9 pack-years; P =.002) and a higher prevalence of smoking-related comorbid conditions and were more likely to use cigarettes during the study period (46.0% vs 13.5%; P<.001).


CONCLUSIONS
Health care utilization among COPD patients is approximately twice that of age- and sex-matched controls, with much of the difference attributable to smoking-related diseases. In this health maintenance organization, inpatient costs were similar to and outpatient costs were much higher than national averages for COPD patients covered by Medicare.
Mapel
D W
DW
Epidemiology and Cancer Control Program, University of New Mexico Health Sciences Center, 2325 Camino de Salud NE, Albuquerque, NM 87131-5306, USA. dmapel@salud.unm.edu
Hurley
J S
JS
Frost
F J
FJ
Petersen
H V
HV
Picchi
M A
MA
Coultas
D B
DB
D000368:Aged; D016022:Case-Control Studies; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000628:therapy; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009516:New Mexico; D010045:Outpatients / Q000706:statistics & numerical data; D012907:Smoking / Q000009:adverse effects / Q000191:economics; D015206:Southwestern United States; D014481:United States; D014600:Utilization Review / Q000191:economics / Q000706:statistics & numerical data*