Drivers of High Hospital Costs for Patients With COPD

The majority of costs associated with chronic obstructive pulmonary disease (COPD) are associated with hospitalizations, and a new study in the International Journal of COPD set out to determine the exact drivers of high costs among hospitalized patients with COPD.

Previous studies have focused on disease-specific risk factors that lead to hospitalization and readmission for this group of patients. COPD is expensive, and is expected to cost the United States $49 billion annually by 2020.

“It is possible that high hospitalization costs among COPD patients may be driven as much by the patient’s functional ability than COPD-specific factors alone,” the authors wrote. “In order to explore this potential relationship, it is necessary to have a better understanding of individual patient characteristics and types of hospital services used by COPD patients.”

The researchers conducted a retrospective observational cohort study using data from the Ottawa Hospital. A total of 1894 patients were included. They had a mean age of 73 years with one-third of them being older than age 80.

The study identifies 2 populations of patients with COPD: first, those with acute severe illness who required intensive care unit admissions and those who died in the hospital setting; and second, those who are not able to cope well at home. Both of these groups contributed to high costs during hospitalizations for COPD.

The authors suggest that since there is little overlap between the 2 groups that early recognition and intervention for people who are frail and functionally limited may result in significant cost savings for hospitals. Patients in the second group require an alternate level of care, typically incur higher allied health professional costs and were discharged to either long-term care facilities or home with home care services.

“If hospital costs are to be saved in this group of patients, early identification of patients with chronic disease and poor functional status in the community setting could help initiate early introduction of support services and arrangement for assisted living facilities,” the authors determined.

Focusing on interventions that identify frail patients with poor or declining functional status could reduce costs for the health system, they wrote.

“Specifically, functional assessments at home, better and earlier discussions of advanced care directives, and reorganization of hospital care based on frailty and functional status may improve the quality of care and reduce costs for patients with COPD and other chronic medical diseases,” the authors concluded.