OBJECTIVES: The objectives of this study are to estimate the excess economic burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap (ACO) among older adults in the United States and to evaluate the extent to which group differences in patient-level characteristics contribute to this excess economic burden.

METHODS: We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Economic burden was measured by total, third-party healthcare expenditures and patients’ out-of-pocket spending (i.e. spending more than 10% of income on healthcare). Generalized Linear Models (GLM) and post-regression linear and non-linear decomposition methods were used to analyze the excess economic burden of ACO.

RESULTS: Older adults with ACO had unfavorable profiles including a higher number of prescription medications utilized (mean 16.12+7.27 vs. 7.53+5.32) and increased levels of fragmented care (78.08+12.01 vs. 66.80+22.17). Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those without asthma and COPD. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. Nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and increased incidence of fragmented care were the leading contributors of the excess economic burden among older adults with ACO.

CONCLUSIONS: Interventions that reduce number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.