HealthCore Inc., Wilmington, DE 19801, USA.
J Med Econ. 2013;16(3):421-9. doi: 10.3111/13696998.2013.766614. Epub 2013 Jan 29.
This study aimed to examine the real-world healthcare resource utilization (HCRU) and direct costs among chronic bronchitis (CB) patients treated with chronic obstructive pulmonary disease (COPD) maintenance medications.
This retrospective analysis utilized administrative claims data from 14 US commercial managed care plans. Eligible patients were ≥40 years old, had ≥2 years of continuous enrollment, ≥1 CB (ICD-9-CM code 491.xx) hospitalization or emergency department (ED) visit or ≥2 office visits between 1/1/2004 and 5/31/2011, and had ≥2 pharmacy fills for COPD medications during follow-up (first fill served as the index date). All-cause and COPD-related HCRU and costs were assessed during follow-up. Multivariate models were utilized to identify predictors of total costs.
Treated CB patients (n = 17,382; 50.6% female; mean age 66.7 (SD = 11.4) years) had a mean of 7.6 (SD = 6.3) COPD maintenance medication fills during follow-up. Overall, 32.6% of patients had ≥1 COPD-related inpatient hospitalizations, 12.9% had ≥1 ED visit, and 81.8% had ≥1 office visit. Mean all-cause and COPD-related total costs were $25,747 (SD = $51,105) and $12,609 (SD = $36,801), respectively, during follow-up. Among the sub-group with ≥1 exacerbation during baseline year, 42.3% had ≥1 COPD-related inpatient hospitalization, 18.5% had ≥1 ED visit, and 88.2% had ≥1 office visit. Mean follow-up all-cause and COPD-related total costs were $29,861 (SD = $49,799) and $16,784 (SD = $34,170), respectively. The number of baseline exacerbations was a significant predictor of all-cause and COPD-related total costs during follow-up.
This study lacked standard measures of CB severity; however, severity proxies were utilized.
HCRU and costs among CB patients were substantial during follow-up, despite treatment with COPD maintenance medications. Additional interventions aiming to prevent or reduce HCRU and costs among CB patients warrant exploration.
本研究旨在考察接受慢性阻塞性肺疾病（COPD）维持治疗药物治疗的慢性支气管炎（CB）患者的实际医疗资源利用（HCRU）和直接成本。
这是一项回顾性分析，利用了来自美国 14 个商业管理式医疗保健计划的行政索赔数据。合格患者年龄≥40 岁，连续入组≥2 年，在 2004 年 1 月 1 日至 2011 年 5 月 31 日期间有≥2 次 CB（ICD-9-CM 代码 491.xx）住院或急诊（ED）就诊或≥2 次门诊就诊，且在随访期间有≥2 次 COPD 药物处方（首次处方作为索引日期）。在随访期间评估全因和 COPD 相关 HCRU 和成本。使用多变量模型确定总费用的预测因素。
接受治疗的 CB 患者（n=17382；50.6%为女性；平均年龄 66.7[SD=11.4]岁）在随访期间平均有 7.6（SD=6.3）次 COPD 维持药物处方。总体而言，32.6%的患者有≥1 次 COPD 相关住院治疗，12.9%有≥1 次 ED 就诊，81.8%有≥1 次门诊就诊。平均全因和 COPD 相关总费用分别为 25747 美元（SD=51105 美元）和 12609 美元（SD=36801 美元）。在基线年度有≥1 次加重的亚组中，42.3%有≥1 次 COPD 相关住院治疗，18.5%有≥1 次 ED 就诊，88.2%有≥1 次门诊就诊。平均随访全因和 COPD 相关总费用分别为 29861 美元（SD=49799 美元）和 16784 美元（SD=34170 美元）。基线加重次数是随访期间全因和 COPD 相关总费用的显著预测因素。
本研究缺乏 CB 严重程度的标准衡量标准；然而，使用了严重程度的替代指标。
尽管接受了 COPD 维持治疗药物，但 CB 患者在随访期间的 HCRU 和费用仍然很高。需要探索针对 CB 患者减少 HCRU 和费用的额外干预措施。
