The direct medical costs of undiagnosed chronic obstructive pulmonary disease.
OBJECTIVE
To estimate the costs of undiagnosed chronic obstructive pulmonary disease (COPD) by describing inpatient, outpatient, and pharmacy utilization in the years before and after the diagnosis.


METHODS
A total of 6,864 patients who were enrolled in the Lovelace Health Plan for at least 12 months during the study period (January 1, 1999 through December 31, 2004) were identified. The first date that utilization was attributed to COPD was considered the first date of diagnosis. Each COPD case was matched to up to three age- and sex-matched controls. All utilization and direct medical costs during the study period were compiled monthly and compared based on the time before and after the initial diagnosis.


RESULTS
Total costs were higher by an average of $1,182 per patient in the 2 years before the initial COPD diagnosis, and $2,489 in the 12 months just before the initial diagnosis, compared to matched controls. Most of the higher cost for undiagnosed COPD was attributable to hospitalizations. Inpatient costs did not increase after the diagnosis was made, but approximately one-third of admissions after the diagnosis were attributed to respiratory disease. Outpatient and pharmacy costs did not differ substantially between cases and matched controls until just a few months before the initial diagnosis, but remained 50% to 100% higher than for controls in the 2 years after diagnosis.


CONCLUSIONS
Undiagnosed COPD has a substantial impact on health-care costs and utilization in this integrated managed care system, particularly for hospitalizations.
Mapel
Douglas W
DW
Lovelace Clinic Foundation, Albuquerque, NM 87106-4264, USA. Doug@LCFresearch.org
Robinson
Scott B
SB
Dastani
Homa B
HB
Shah
Hemal
H
Phillips
Amy L
AL
Lydick
Eva
E
D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009516:New Mexico / Q000453:epidemiology; D004364:Pharmaceutical Preparations / Q000191:economics; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D017678:Sex Distribution; D018709:Statistics, Nonparametric
D004364:Pharmaceutical Preparations