title: Determinants of elevated healthcare utilization in patients with COPD.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system.
  
  
  METHODS
  Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL) indices were obtained using validated questionnaires among a subsample of 177 patients.
  
  
  RESULTS
  Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p < 0.001). The "most-costly" upper 25% of COPD patients (n = 98) consumed 63% of all costs. Multivariate analysis revealed that independent determinants of being in the "most costly" group were (OR; 95% CI): age-adjusted Charlson Comorbidity Index (1.09; 1.01-1.2), history of: myocardial infarct (2.87; 1.5-5.5), congestive heart failure (3.52; 1.9-6.4), mild liver disease (3.83; 1.3-11.2) and diabetes (2.02; 1.1-3.6). Bivariate analysis revealed that cost increased as HRQoL declined and severity of airflow obstruction increased but these were not independent determinants in a multivariate analysis.
  
  
  CONCLUSIONS
  Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.
authors.affiliation: Department of Health Systems Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University, Beer-Sheva, Israel. simont@bgu.ac.il
authors.forename: Tzahit
authors.initials: T
authors.lastname: Simon-Tuval
authors.forename: Steven M
authors.initials: SM
authors.lastname: Scharf
authors.forename: Nimrod
authors.initials: N
authors.lastname: Maimon
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Bernhard-Scharf
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
authors.forename: Ariel
authors.initials: A
authors.lastname: Tarasiuk
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016018:Least-Squares Analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D018855:Single-Payer System / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome