OBJECTIVES: Suboptimal treatment of exacerbations is a major concern in management of chronic obstructive pulmonary disease (COPD). A COPD HEDIS quality measure focuses on appropriate use of inhaled bronchodilators after an exacerbation. There is limited evidence demonstrating the association between these quality measures and healthcare costs. This study aims to evaluate impact of patient characteristics, including receipt of appropriate pharmacotherapy with an inhaled bronchodilator (PCE-D) as defined by HEDIS, on healthcare costs following a COPD exacerbation. METHODS: This retrospective, observational study identified the first observed COPD-related hospital and ED visit per patient per year (index event) between 2007 and 2013 from a Central Texas health plan. Pre-index characteristics were collected. Patients enrolled six months post-discharge were included in the analysis. Generalized estimating equations were used to assess the impact of pre-index/index variables and receipt of PCE-D ± 30 days post discharge on 6-month follow-up healthcare costs. Subjects receiving PCE-D were matched on age, gender, and time of admission to those that did not receive PCE-D.  RESULTS: A total of 210 COPD admissions were identified (matched 2:1). All-cause costs in the 6-month period post-discharge were similar between those who received PCE-D vs those that did not ($13,750 vs $9,981, p=0.23). However, COPD-related costs were higher in the PCE-D group ($2,181 vs $1,017, p=0.01). Higher COPD-related costs were more likely for older patients (RR=1.06, p<0.01) and those with greater pre-index COPD-related costs (RR=1.004, p<0.01). Factors associated with greater all-cause follow-up costs were higher pre-index all-cause costs (RR=1.002, p<0.01) and longer length of stay (LOS) at baseline admission (RR=1.08, p=0.01). CONCLUSIONS: Higher all-cause and COPD-related costs observed in the post-exacerbation period were correlated with increased age, greater baseline costs, and longer length of initial inpatient stay. Patients with more severe disease may be more likely to receive a bronchodilator post-discharge. This study was funded by GSK (HO-14-15081).