Department of Health Systems Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University, Beer-Sheva, Israel.
Respir Res. 2011 Jan 13;12(1):7. doi: 10.1186/1465-9921-12-7.
Chronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system.
Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL) indices were obtained using validated questionnaires among a subsample of 177 patients.
Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p < 0.001). The "most-costly" upper 25% of COPD patients (n = 98) consumed 63% of all costs. Multivariate analysis revealed that independent determinants of being in the "most costly" group were (OR; 95% CI): age-adjusted Charlson Comorbidity Index (1.09; 1.01-1.2), history of: myocardial infarct (2.87; 1.5-5.5), congestive heart failure (3.52; 1.9-6.4), mild liver disease (3.83; 1.3-11.2) and diabetes (2.02; 1.1-3.6). Bivariate analysis revealed that cost increased as HRQoL declined and severity of airflow obstruction increased but these were not independent determinants in a multivariate analysis.
Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.
慢性阻塞性肺疾病（COPD）给西方医疗体系带来了巨大的经济负担。我们的目的是分析在单一支付者医疗体系中，COPD 患者医疗利用度升高的决定因素。
通过年龄、性别和居住地区，将 389 名 COPD 成人与对照组进行 1:3 配对。在招募前 5 年从计算机数据库中获取总医疗费用和合并症的存在情况。在 177 名患者的亚样本中，使用经过验证的问卷获得健康相关生活质量（HRQoL）指数。
与对照组相比，COPD 患者的医疗利用度高出 3.4 倍（p < 0.001）。“最昂贵”的前 25%的 COPD 患者（n = 98）消耗了所有费用的 63%。多变量分析显示，属于“最昂贵”组的独立决定因素是（OR；95%CI）：年龄调整 Charlson 合并症指数（1.09；1.01-1.2）、心肌梗死史（2.87；1.5-5.5）、充血性心力衰竭（3.52；1.9-6.4）、轻度肝病（3.83；1.3-11.2）和糖尿病（2.02；1.1-3.6）。双变量分析显示，随着 HRQoL 的下降和气流阻塞的严重程度的增加，成本会增加，但在多变量分析中，这些不是独立的决定因素。
合并症负担决定了 COPD 患者的医疗利用率升高。决策者应该优先考虑稀缺的医疗资源，为“最昂贵”的患者提供更好的医疗管理。
