Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany; Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany.
AOK Bayern, Service Center of Health Care Management, Regensburg, Germany.
Respir Med. 2020 Dec;175:106194. doi: 10.1016/j.rmed.2020.106194. Epub 2020 Nov 3.
Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation, which is progressive and not fully reversible. In patients with COPD, body mass index (BMI) is an important parameter associated with health outcomes, e.g. mortality and health-related quality of life. However, so far no study evaluated the association of BMI and health care expenditures across different COPD severity grades. We used claims data and documentation data of a Disease Management Program (DMP) from a statutory health insurance fund (AOK Bayern). Patients were excluded if they had less than 4 observations in the 8 years observational period. Generalized additive mixed models with smooth functions were used to evaluate the association between BMI and health care expenditures, stratified by severity of COPD, indicated by GOLD grades 1-4. We included 30,682 patients with overall 188,725 observations. In GOLD grades 1-3 we found an u-shaped relation of BMI and expenditures, where patients with a BMI of 30 or slightly above had the lowest and underweight and obese patients had the highest health care expenditures. Contrarily, in GOLD grade 4 we found an almost linear decline of health care expenditures with increasing BMI. In terms of expenditures, the often reported obesity paradox in patients with COPD was clearly reflected in GOLD grade 4, while in all other severity grades underweight as well as severely obese patients caused the highest health care expenditures. Reduction of obesity may thus reduce health care expenditures in GOLD grades 1-3.
慢性阻塞性肺疾病（COPD）的特征是持续的呼吸道症状和气流受限，这种情况是进行性的，且不完全可逆。在 COPD 患者中，体重指数（BMI）是与健康结果相关的一个重要参数，例如死亡率和与健康相关的生活质量。然而，迄今为止，尚无研究评估 BMI 与不同 COPD 严重程度等级的医疗保健支出之间的关系。我们使用了来自法定健康保险基金（AOK Bayern）的疾病管理计划（DMP）的索赔数据和文件数据。如果患者在 8 年观察期内观察次数少于 4 次，则将其排除在外。使用广义加性混合模型和光滑函数来评估 BMI 与医疗保健支出之间的关联，按 COPD 的严重程度（由 GOLD 等级 1-4 表示）进行分层。我们纳入了 30682 名患者，共有 188725 次观察。在 GOLD 等级 1-3 中，我们发现 BMI 和支出之间存在 U 型关系，其中 BMI 为 30 或略高的患者支出最低，而体重不足和肥胖患者的医疗保健支出最高。相反，在 GOLD 等级 4 中，我们发现随着 BMI 的增加，医疗保健支出几乎呈线性下降。就支出而言，在 COPD 患者中经常报道的肥胖悖论在 GOLD 等级 4 中得到了清晰体现，而在所有其他严重程度等级中，体重不足和严重肥胖患者导致的医疗保健支出最高。因此，在 GOLD 等级 1-3 中，减轻肥胖可能会降低医疗保健支出。
