OBJECTIVES: Some COPD patients experience multiple - and preventable - COPD exacerbations, which are associated with excessive healthcare resource utilization and costs. Using large-scale Medicare claims, we characterized the use and cost burdens in COPD patients with frequent exacerbations compared to those with infrequent exacerbations.

METHODS: This retrospective cohort study used a nationally representative 5% Medicare claims in 2014. We included adults with COPD aged 65+ with 12-months continuous enrollment in Parts A, B, and D. Beneficiaries with Medicare Advantage were excluded. Frequent exacerbation was defined as ≥2 hospitalization or emergency visits in 12 months. We reported healthcare resource utilization, total health services costs, and total COPD medication costs per beneficiary.

RESULTS: Of 92,318 eligible beneficiaries, 3,338 (3.6%) experienced frequent exacerbations. The groups with and without frequent exacerbations were 58% female, 87% white, and aged 76 and 78 years, respectively. Among those with frequent exacerbations, incidence rates for COPD-related hospitalization and outpatient visits were 161 and 410 (per 100 person-year); while rates for all-cause visits were 184 and 1,078, respectively. The corresponding COPD-related and all-cause rates for hospitalization and outpatient visits observed in those without frequent exacerbations were 44 and 74; and 123 and 755. Mean (SD) annual health services cost was $31,421 ($34,620) and $19,207 ($29,414) per beneficiary with and without frequent exacerbations, respectively. Mean (SD) cost for COPD-related services were $21,203 ($27,077) and $7,170 ($15,342), respectively. Each frequent exacerbation patient spent $2,635 ($3,518) annually on COPD medications, while those without frequent exacerbations spent $1,277 ($2,021).

CONCLUSIONS: Older COPD patients experience excessive clinical and economic burdens. Frequent exacerbations are associated with substantially higher service utilization and costs compared to those without frequent exacerbations. Optimal disease management will benefit all COPD patients, especially those suffering multiple COPD exacerbations.