Understanding of COPD Exacerbations and Related Costs

Patient-reported symptoms in chronic obstructive pulmonary disease (COPD) may contribute information that can be used to infer future exacerbations and related costs, according to a study published in International Journal of Chronic Obstructive Pulmonary Disease.

The Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines recommends an advanced assessment of COPD using the modified Medical Research Council (mMRC) or COPD assessment test (CAT) score. Using these tests in addition to regular diagnosis of the degree of airflow obstruction and exacerbation history helps in understanding the symptoms more efficiently.

COPD is a leading health problem and if untreated or undertreated, it could lead to death. In 2011, 6.3% of the adults in US older than 18 years of age were diagnosed positive for COPD. The incidence of the disease increases furthermore in older age groups. More commonly diagnosed in women than in men, COPD generates great interest in incorporating symptomatology.

However, despite the abundance of the symptomatology information, very little is known about its association to future exacerbations. As a result, healthcare providers cannot determine the medical cost associated with the understudied disease.

Study Process

Margaret K. Pasquale, PhD, and colleagues mailed the mMRC and CAT to a random study group of 4000 Medicare members. All were older than 40 years old and diagnosed with COPD. Patients who had an organ transplant, were pregnant, or suffered from cancer were excluded. The exacerbations and exacerbation-related costs were collected from claims data during 365-day post-survey.

Results of the Study

Out of the 4000 survey members, a total of 1159 answered the survey. The mean age of the respondents was 72 years. Out of the respondents, 53.7% were female and 91.2% were white.

Members with pre-index exacerbations of 1, 2, and greater than 3 had the odds of experiencing post-index exacerbations 3.06, 4.55, and 16.28 times, respectively. The odds ratio for high vs. low symptoms using CAT was 2.51.

Furthermore, as the pre-index exacerbation incremented, the exacerbation-related costs too increased. The costs were 73% higher with each increment. Similarly, the exacerbation-related cost was 4 times higher for high- vs low-symptom patients using CAT. The mMRC symptoms, however, were not statistically significant.

What It Means

COPD is a progressive health condition that blocks the airflow making it extremely difficult to breathe. If the respiratory symptoms are under diagnosed, they may worsen leading to exacerbation.

If the patient suffers from exacerbation, it is natural to expect hospitalization and emergency room visits because of the severe decline in the functioning of the lungs. Such acute healthcare emergencies can result in enormous costs. In 2010, the direct and indirect COPD-related costs amounted to $36 billion.

That’s why the GOLD guidelines have been broadened to include a combined assessment of COPD severity. The symptomology can be tracked using the mMRC score as well as the CAT scores. These patient-related symptoms provide crucial information that can help predict and account for future COPD exacerbations and exacerbation-related costs. This process covers up for the gap that predicting medical costs by simply understanding the exacerbation history leaves.