title: Healthcare utilization and costs among chronic bronchitis patients treated with maintenance medications from a US managed care population.
abstract: OBJECTIVE
  This study aimed to examine the real-world healthcare resource utilization (HCRU) and direct costs among chronic bronchitis (CB) patients treated with chronic obstructive pulmonary disease (COPD) maintenance medications.
  
  
  METHODS
  This retrospective analysis utilized administrative claims data from 14 US commercial managed care plans. Eligible patients were ≥40 years old, had ≥2 years of continuous enrollment, ≥1 CB (ICD-9-CM code 491.xx) hospitalization or emergency department (ED) visit or ≥2 office visits between 1/1/2004 and 5/31/2011, and had ≥2 pharmacy fills for COPD medications during follow-up (first fill served as the index date). All-cause and COPD-related HCRU and costs were assessed during follow-up. Multivariate models were utilized to identify predictors of total costs.
  
  
  RESULTS
  Treated CB patients (n = 17,382; 50.6% female; mean age 66.7 (SD = 11.4) years) had a mean of 7.6 (SD = 6.3) COPD maintenance medication fills during follow-up. Overall, 32.6% of patients had ≥1 COPD-related inpatient hospitalizations, 12.9% had ≥1 ED visit, and 81.8% had ≥1 office visit. Mean all-cause and COPD-related total costs were $25,747 (SD = $51,105) and $12,609 (SD = $36,801), respectively, during follow-up. Among the sub-group with ≥1 exacerbation during baseline year, 42.3% had ≥1 COPD-related inpatient hospitalization, 18.5% had ≥1 ED visit, and 88.2% had ≥1 office visit. Mean follow-up all-cause and COPD-related total costs were $29,861 (SD = $49,799) and $16,784 (SD = $34,170), respectively. The number of baseline exacerbations was a significant predictor of all-cause and COPD-related total costs during follow-up.
  
  
  CONCLUSIONS
  This study lacked standard measures of CB severity; however, severity proxies were utilized.
  
  
  CONCLUSIONS
  HCRU and costs among CB patients were substantial during follow-up, despite treatment with COPD maintenance medications. Additional interventions aiming to prevent or reduce HCRU and costs among CB patients warrant exploration.
authors: HealthCore Inc., Wilmington, DE 19801, USA. aabudagga@healthcore.com
authors: Azza
authors: A
authors: AbuDagga
authors: Shawn X
authors: SX
authors: Sun
authors: Hiangkiat
authors: H
authors: Tan
authors: Caitlyn T
authors: CT
authors: Solem
mesh_terms: D000328:Adult; D000368:Aged; D029481:Bronchitis, Chronic / Q000188:drug therapy / Q000191:economics*; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D060046:Maintenance Chemotherapy / Q000191:economics*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States