Abstract
ObjectivesTo estimate the incidence of pneumonia by COPD status and the excess cost of inpatient primary pneumonia in elders with COPD.Study DesignA retrospective, longitudinal study using claims linked to eligibility/demographic data for a 5% sample of fee-for-service Medicare beneficiaries from 2005 through 2007.MethodsIncidence rates of pneumonia were calculated for elders with and without COPD and for elders with COPD and coexistent congestive heart failure (CHF). Propensity-score matching with multivariate generalized linear regression was used to estimate the excess direct medical cost of inpatient primary pneumonia in elders with COPD as compared with elders with COPD but without a pneumonia hospitalization.ResultsElders with COPD had nearly six-times the incidence of pneumonia compared with elders without COPD (167.6/1000 person-years versus 29.5/1000 person-years; RR=5.7, p <0 .01); RR increased to 8.1 for elders with COPD and CHF compared with elders without COPD. The incidence of inpatient primary pneumonia among elders with COPD was 54.2/1000 person-years compared with 7/1000 person-years for elders without COPD; RR=7.7, p<0.01); RR increased to 11.0 for elders with COPD and CHF compared with elders without COPD. The one-year excess direct medical cost of inpatient pneumonia in COPD patients was $ 22,697 ($45,456 in cases vs. $ 22,759 in controls (p <0.01)); 70.2% of this cost was accrued during the quarter of the index hospitalization. During months 13 through 24 following the index hospitalization, the excess direct medical cost was $ 5,941 ($23,215 in cases vs. $ 17,274 in controls, p<0.01).ConclusionsPneumonia occurs more frequently in elders with COPD than without COPD. The excess direct medical cost in elders with inpatient pneumonia extends up to 24 months following the index hospitalization and represents $28,638 in 2010 dollars.
Highlights
Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, is the fourth leading cause of death among persons age 65 years and above in the U.S COPD in the elderly results in an increased risk of hospital admission for infectious disease such as pneumonia, increased morbidity and mortality, and increased health care costs[1,2]
To ensure the protection of beneficiaries' privacy, the data use agreement (DUA) was reviewed by the CMS Privacy Board, the data were maintained securely with access limited to authorized persons, and the study was approved by the Brandeis University Institutional Review Board (IRB) and its HIPAA board as well as the Centers for Medicare & Medicaid Services
Persons with COPD were slightly older and less likely to be female, twice as likely to have Medicare eligibility based upon disability or ESRD, and more likely to live in areas where median household incomes were in the lowest quartile
Summary
Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, is the fourth leading cause of death among persons age 65 years and above in the U.S COPD in the elderly results in an increased risk of hospital admission for infectious disease such as pneumonia, increased morbidity and mortality, and increased health care costs[1,2]. Individuals with COPD experience one to three exacerbations a year with some going undiagnosed and the most severe requiring hospitalization[4,5]. Acute exacerbations in those with COPD are caused by upper respiratory tract infections, environmental exposures, and lower respiratory tract infections such as pneumonia. COPD is a disease characterized by frequent acute exacerbations, progressive lung impairment, and upper and lower respiratory tract infections including pneumonia[6]. Older persons with chronic respiratory diseases such as COPD are at increased risk of contracting pneumonia and associated death[1,7,8,9]
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