PRS7 Characteristics, Cost and Health Care Resource Use in a Population of Medicare Fee-for-Service (FFS) Patients with Chronic Obstructive Pulmonary Disease (COPD) Who Also Experience Pneumonia

Abstract

Patients with COPD are at increased risk for lung infections, such as pneumonia. However, few studies have characterized the impact of pneumonias on health care resource utilization (HRU) and cost in Medicare Fee-for-Service (FFS) patients. The objective of this study was to characterize and estimate outcomes among patients with pneumonia, compared to those without pneumonia. A retrospective analysis of COPD patients between 1/1/2016 and 12/31/2017 using FFS claims was conducted. To evaluate HCRU and costs, propensity scoring and exact matching were used to create a one-to-one matched cohort of incident pneumonia patients to those without pneumonia. Patient demographics, comorbidities (Charleston Comorbidity Index [CCI]), and treatments were evaluated before and after matching. HCRU and associated healthcare costs were assessed during the 12-months post-index. Regression models were utilized to compare adjusted outcomes between groups after matching. In the baseline cohort of 2.46M patients, incident pneumonia patients (15.5%) were older (mean age: 73.7 vs. 71.9 years), with more comorbidities (CCI: 4.5 vs. 3.1). 35.7% of pneumonia patients experienced ≥1 baseline exacerbation vs. 13.2% without pneumonia (unadjusted OR: 3.65; p<0.05). After matching, demographic and clinical differences between groups were balanced with N=330,435 in each cohort. In the matched cohort, post-index HCRU after pneumonia event were significantly higher (all p<0.05) for hospitalizations (65.8% vs. 35.9%), ER visits (58.3% vs. 53.1%), and outpatient office visits (94.1% vs. 92.2%) versus the control cohort. Matched unadjusted post-index mean all-cause costs were 58.9% higher in the pneumonia cohort ($53,268; 95% CI: $52,812-$53,734, p<0.0001) compared to those without pneumonia ($33,523; 95% CI: $33.402-$33,644, p<0.0001). After adjustment total costs remained 51.9% higher for the pneumonia cohort. Patients with COPD who experience pneumonia also experience more exacerbations and have significantly higher total HRU and costs when compared to non-pneumonia patients, primarily driven by the difference in hospitalizations.