OBJECTIVES: Globally, chronic obstructive pulmonary disease (COPD) is associated with substantial economic burden to healthcare systems. This study examined real-world healthcare resource use (HCRU), costs and HCRU predictors in patients with COPD in the United States.

METHODS: Patients aged ≥40 years were identified from administrative claims data 1/1/16-12/31/17 based on the following: 1 COPD-related hospitalization or 1 COPD-related emergency department (ED) claim or 2 other COPD-related claims with different service dates (index date). Patients were followed for 2 years (baseline period [Year 1], outcomes [Year 2]). COPD complexity, a proxy for disease severity, was classified as high, moderate, or low based on comorbid respiratory conditions. Annual all-cause and COPD-related HCRU (hospitalizations, ED visits, office visits) and estimated paid costs were assessed post-index. Predictors of HCRU were assessed using multivariable logistic regression models.

RESULTS: 1,123,924 patients were included; mean (±SD) age was 63.1±11.1 years, 56.2% were female, and 96.6% had ≥1 comorbidity. Cohort COPD complexity was categorized as low (41.9%), moderate (49.7%), and high (8.4%). Overall, mean (±SD) per-patient all-cause and COPD-related hospitalizations were 0.30±0.92 and 0.04±0.31, respectively, and all-cause and COPD-related ED visits were 1.08±2.81 and 0.30±1.14, respectively. Among all patients, unadjusted annual COPD-related costs per-patient were highest for prescriptions ($953±$1,726) and comparable for hospitalizations ($478±$4,051) and ED visits ($479±$2,040). HCRU and costs for all service types increased with increasing disease complexity. Significant predictors of having any COPD-related hospitalizations included having baseline COPD-related hospitalizations, older age, moderate/high COPD complexity, and certain comorbidities (eg, heart failure, pneumonia) (all p<0.001). Significant predictors of having any COPD-related ED visits included having baseline COPD-related ED visits or hospitalizations, payer type, moderate/high COPD complexity, any rescue medication use, and certain comorbidities (eg, heart failure, asthma, anxiety) (all p<0.001).

CONCLUSIONS: This recent analysis continues to demonstrate that disease complexity and comorbid conditions contribute substantially to the economic burden of COPD.