title: COPD exacerbation frequency and its association with health care resource utilization and costs.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) exacerbations account for a substantial proportion of COPD-related costs.
  
  
  OBJECTIVE
  To describe COPD exacerbation patterns and assess the association between exacerbation frequency and health care resource utilization (HCRU) and costs in patients with COPD in a Medicare population.
  
  
  METHODS
  A retrospective cohort study utilizing data from a large US national health plan was conducted including patients with a COPD diagnosis during January 1, 2007 to December 31, 2012, aged 40-89 years and continuously enrolled in a Medicare Advantage Prescription Drug plan. Exacerbation frequency, HCRU, and costs were assessed during a 24-month period following the first COPD diagnosis (follow-up period). Four cohorts were created based on exacerbation frequency (zero, one, two, and ≥three). HCRU and costs were compared among the four cohorts using chi-square tests and analysis of variance, respectively. A trend analysis was performed to assess the association between exacerbation frequency and costs using generalized linear models.
  
  
  RESULTS
  Of the included 52,459 patients, 44.3% had at least one exacerbation; 26.3%, 9.5%, and 8.5% had one, two, and ≥three exacerbations in the 24-month follow-up period, respectively. HCRU was significantly different among cohorts (all P<0.001). In patients with zero, one, two, and ≥three exacerbations, the percentages of patients experiencing all-cause hospitalizations were 49.7%, 66.4%, 69.7%, and 77.8%, respectively, and those experiencing COPD-related hospitalizations were 0%, 40.4%, 48.1%, and 60.5%, respectively. Mean all-cause total costs (medical and pharmacy) were more than twofold greater in patients with ≥three exacerbations compared to patients with zero exacerbations ($27,133 vs $56,033; P<0.001), whereas a greater than sevenfold difference was observed in mean COPD-related total costs ($1,605 vs $12,257; P<0.001).
  
  
  CONCLUSIONS
  COPD patients frequently experience exacerbations. Increasing exacerbation frequency is associated with a multiplicative increase in all-cause and COPD-related costs. This underscores the importance of identifying COPD patients at risk of having frequent exacerbations for appropriate disease management.
authors.affiliation: Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA.
authors.forename: Amol D
authors.initials: AD
authors.lastname: Dhamane
authors.affiliation: Comprehensive Health Insights Inc., Louisville, KY, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Moretz
authors.affiliation: Comprehensive Health Insights Inc., Louisville, KY, USA.
authors.forename: Yunping
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Burslem
authors.affiliation: Comprehensive Health Insights Inc., Louisville, KY, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Saverno
authors.affiliation: Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA.
authors.forename: Gagan
authors.initials: G
authors.lastname: Jain
authors.affiliation: Humana Inc., Louisville, KY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Renda
authors.affiliation: Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA.
authors.forename: Shuchita
authors.initials: S
authors.lastname: Kaila
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D018450:Disease Progression; D016527:Drug Costs; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D020398:Medicare Part C / Q000191:economics*; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; costs; exacerbations; frequency