Background: In light of overall increasing healthcare expenditures, it is mandatory to study determinants of future costs in chronic diseases. This study reports the first longitudinal results on healthcare utilization and associated costs from the German chronic obstructive pulmonary disease (COPD) cohort COSYCONET. Material and methods: Based on self-reported data of 1904 patients with COPD who attended the baseline and 18-month follow-up visits, direct costs were calculated for the 12 months preceding both examinations. Direct costs at follow-up were regressed on baseline disease severity and other co-variables to identify determinants of future costs. Change score models were developed to identify predictors of cost increases over 18 months. As possible predictors, models included GOLD grade, age, sex, education, smoking status, body mass index, comorbidity, years since COPD diagnosis, presence of symptoms, and exacerbation history. Results: Inflation-adjusted mean annual direct costs increased by 5% (n.s., euro6,739 to euro7,091) between the two visits. Annual future costs were significantly higher in baseline GOLD grades 2, 3, and 4 (factors 1.24, 95%-confidence interval [1.07-1.43], 1.27 [1.09-1.48], 1.57 [1.27-1.93]). A history of moderate or severe exacerbations within 12 months, a comorbidity count >3, and the presence of dyspnea and underweight were significant predictors of cost increase (estimates ranging between + euro887 and + euro3,679, all p<0.05). Conclusions: Higher GOLD grade, comorbidity burden, dyspnea and moderate or severe exacerbations were determinants of elevated future costs and cost increases in COPD. In addition we identified underweight as independent risk factor for an increase in direct healthcare costs over time.
- Byng, D.
- Lutter, J. I.
- Wacker, M. E.
- Jorres, R. A.
- Liu, X.
- Karrasch, S.
- Schulz, H.
- Vogelmeier, C.
- Holle, R.
Keywords
- Aged
- Ambulatory Care
- Comorbidity
- Disease Progression
- Dyspnea/economics/epidemiology/therapy
- Female
- Germany/epidemiology
- *Health Care Costs
- *Health Expenditures
- Hospital Costs
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Outcome and Process Assessment, Health Care/*economics
- Prospective Studies
- Pulmonary Disease, Chronic Obstructive/diagnosis/*economics/epidemiology/*therapy
- Quality of Life
- Risk Factors
- Severity of Illness Index
- Thinness/economics/epidemiology/therapy
- Time Factors
- Treatment Outcome
- *change score
- *direct costs
- *healthcare expenditures
- *inpatient costs
- *outpatient costs
- *population-based
- Research during the conduct of the study. Stefan Karrasch reports grants from
- German Federal Ministry of Education and Research (BMBF) during the conduct of
- the study. Holger Schulz report grants from German Federal Ministry of Education
- and Research (BMBF), during the conduct of the study. Claus Vogelmeier report
- grants and personal fees from AstraZeneca, grants and personal fees from
- Boehringer Ingelheim, personal fees from CSL Behring, personal fees from Chiesi,
- grants and personal fees from GlaxoSmithKline, grants and personal fees from
- Grifols, personal fees from Menarini, personal fees from Mundipharma, grants and
- personal fees from Novartis, personal fees from Teva, personal fees from Cipla,
- grants from Bayer Schering Pharma AG, grants from MSD, and grants from Pfizer
- outside the submitted work. Rolf Holle report grants from German Federal Ministry
- of Education and Research, during the conduct of the study. The authors report no
- other conflicts of interest in this work.