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Direct Medical Costs of COPD in the USA: An Analysis of the Medical Expenditure Panel Survey 2017–2018

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Abstract

Aim

In this study, we aimed to provide a nationally representative estimate of the economic burden of chronic obstructive pulmonary disease (COPD) by examining direct medical costs among individuals aged 45 years and older in the USA.

Methods

Medical Expenditure Panel Survey (2017–2018) data were used to estimate the direct medical costs associated with COPD. All-cause (unadjusted) cost and COPD-specific (adjusted) cost were determined for the various service categories using a regression-based approach among patients with COPD. We developed a weighted two-part model and adjusted for various demographic, socioeconomic, and clinical characteristics.

Results

The study sample consisted of 23,590 patients, of which 1073 had COPD. Patients with COPD had a mean age of 67.4 years (standard error (SE): 0.41), and the total all-cause mean medical cost per patient per year (PPPY) was 2018 US $19,449 (SE: US $865), of which US $6145 (SE: US $295) was for prescription drugs. Using the regression approach, the mean total COPD-specific cost was US $4322 (SE: US $577) PPPY, with prescription drugs contributing US $1887 (SE: 216) PPPY. These results represented an annual total COPD-specific cost of US $24.0 billion, with prescription drugs contributing US $10.5 billion. The mean annual out-of-pocket spending accounted for 7.5% (mean: US $325) of the total COPD-specific cost; for COPD-specific prescription drug cost, 11.3% (mean: US $212) was out-of-pocket cost.

Conclusion

COPD poses a significant economic burden on healthcare payers and patients 45 years of age and older in the USA. While prescription drugs accounted for almost half of the total cost, more than 10% of the prescription drug cost was out-of-pocket.

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References

  1. Raherison C, Girodet P-O. Epidemiology of COPD. Eur Respir Rev. 2009;18:213–21.

    Article  CAS  PubMed  Google Scholar 

  2. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347–65.

    Article  CAS  PubMed  Google Scholar 

  3. Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to copd diagnosis, management, and prevention: a guide for health care professionals. Fontana, Wisconsin; 2020 Edition.

  4. National Center for Health Statistics. Percentage of COPD, emphysema, or chronic bronchitis for adults aged 18 and over, United States, 2019. National Health Interview Survey. 2022. https://wwwn.cdc.gov/NHISDataQueryTool/SHS_2019_ADULT3/index.html.

  5. CDC—Basics About COPD—Chronic Obstructive Pulmonary Disease (COPD). 2019. https://www.cdc.gov/copd/basics-about.html.

  6. Mannino D, Buist A, Petty T, Enright P, Redd S. Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax. 2003;58:388–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Murphy SL. Mortality United States. 2017;2018:8.

    Google Scholar 

  8. Shah CH, Reed RM, Villalonga-Olives E, Slejko JF, Eakin MN, So JY, et al. Quantifying heterogeneity of physical and mental health-related quality of life in chronic obstructive pulmonary disease patients in the United States. Expert Rev Respir Med. 2020;14:937–47 (Taylor & Francis).

    Article  CAS  PubMed  Google Scholar 

  9. Zafari Z, Li S, Eakin MN, Bellanger M, Reed RM. Projecting long-term health and economic burden of chronic obstructive pulmonary disease in the United States. CHEST. Elsevier; 2020;0. https://journal.chestnet.org/article/S0012-3692(20)34848-0/abstract.

  10. Chapel JM, Ritchey MD, Zhang D, Wang G. Prevalence and medical costs of chronic diseases among adult medicaid beneficiaries. Am J Prev Med. 2017;53:S143–54.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Patel JG, Coutinho AD, Lunacsek OE, Dalal AA. COPD affects worker productivity and health care costs. Int J Chron Obstruct Pulmon Dis. 2018;13:2301–11.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dalal AA, Christensen L, Liu F, Riedel AA. Direct costs of chronic obstructive pulmonary disease among managed care patients. Int J Chron Obstruct Pulmon Dis. 2010;5:341–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shah CH, Onukwugha E, Zafari Z, Villalonga-Olives E, Park J, Slejko JF. Economic burden of comorbidities among COPD Patients hospitalized for acute exacerbations: an analysis of a commercially insured population. Expert Rev Pharmacoecon Outcomes Res. 2021;22:1–8. https://doi.org/10.1080/14737167.2021.1981291

  14. Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. economic burden of chronic obstructive pulmonary disease (COPD): a systematic literature review. Int J Chron Obstruct Pulmon Dis. 2020;15:439–60.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lopez E, Claxton G, Schwartz K, Ochieng N. Comparing private payer and medicare payment rates for select inpatient hospital services. KFF. 2020. https://www.kff.org/medicare/issue-brief/comparing-private-payer-and-medicare-payment-rates-for-select-inpatient-hospital-services/.

  16. Comparing Commercial and Medicare Professional Service Prices. HCCI. https://healthcostinstitute.org/hcci-research/comparing-commercial-and-medicare-professional-service-prices.

  17. Bureau UC. Health Insurance Coverage in the United States: 2020. Census.gov. https://www.census.gov/library/publications/2021/demo/p60-274.html.

  18. Centers for Medicare and Medicaid Services. Hospital Readmissions Reduction Program (HRRP). 2019. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html.

  19. Strassels SA, Smith DH, Sullivan SD, Mahajan PS. The costs of treating COPD in the United States. Chest. 2001;119:344–52.

    Article  CAS  PubMed  Google Scholar 

  20. Miller JD, Foster T, Boulanger L, Chace M, Russell MW, Marton JP, et al. Direct costs of COPD in the U.S.: an analysis of Medical Expenditure Panel Survey (MEPS) data. COPD. 2005;2:311–8.

    Article  PubMed  Google Scholar 

  21. Blanchette CM, Dalal AA, Mapel D. Changes in COPD demographics and costs over 20 years. J Med Econ. 2012;15:1176–82.

    Article  PubMed  Google Scholar 

  22. Mann M, Meyer RJ. Drug development for asthma and COPD: a regulatory perspective. Respir Care. 2018;63:797–817.

    Article  PubMed  Google Scholar 

  23. What are the recent and forecasted trends in prescription drug spending?. Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/recent-forecasted-trends-prescription-drug-spending/.

  24. Patient Trends in Hospital Inpatient Stays in the United States, 2005–2014 #225. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb225-Inpatient-US-Stays-Trends.jsp?msclkid=429efea3c33911ec8a63ef8a50af1cd3.

  25. Sistani F, Reed RM, Shah CH, Zafari Z. Trends in Medicaid spending on inhalers in the United States, 2012–2018. JMCP. 2021;27:1744–9.

    Article  PubMed  Google Scholar 

  26. Medical Expenditure Panel Survey Home. https://meps.ahrq.gov/mepsweb/.

  27. Gothe H, Rajsic S, Vukicevic D, Schoenfelder T, Jahn B, Geiger-Gritsch S, et al. Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review. BMC Health Serv Res. 2019;19:737.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ward MM, Javitz HS, Smith WM, Bakst A. Direct medical cost of chronic obstructive pulmonary disease in the U.S.A. Respir Med. 2000;94:1123–9.

    Article  CAS  PubMed  Google Scholar 

  29. Anecchino C, Rossi E, Fanizza C, De Rosa M, Tognoni G, Romero M. Prevalence of chronic obstructive pulmonary disease and pattern of comorbidities in a general population. Int J Chron Obstruct Pulmon Dis. 2007;2:567–74.

    PubMed  PubMed Central  Google Scholar 

  30. Akinbami LJ. Chronic obstructive pulmonary disease among adults aged 18 and over in the United States, 1998–2009. 2011;8.

  31. Medical Expenditure Panel Survey Topics: priority conditions—general. https://meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=41Z-1.

  32. Park RE. Estimation with heteroscedastic error terms. Econometrica. 1966;34:888–888.

    Article  Google Scholar 

  33. Deb P, Norton EC, Manning WG. Health econometrics using Stata. College Station: Stata Press; 2017.

    Google Scholar 

  34. Deb P, Norton EC. Modeling health care expenditures and use. Annu Rev Public Health. 2018;39:489–505.

    Article  PubMed  Google Scholar 

  35. Belotti F, Deb P, Manning WG, Norton EC. Twopm: two-part models. Stata J. 2015;15:3–20.

    Article  Google Scholar 

  36. Tompkins L, Siller AB. Analyzing complex sample survey data: a new beginning. :3.

  37. U.S. Department of Health and Human Services. National Health Expenditure Accounts: Methodology Paper, 2019. 2019;44.

  38. Using appropriate price indices for expenditure comparisons. https://meps.ahrq.gov/about_meps/Price_Index.shtml.

  39. Dunn A, Grosse SD, Zuvekas SH. Adjusting health expenditures for inflation: a review of measures for health services research in the United States. Health Serv Res. 2018;53:175–96.

    Article  PubMed  Google Scholar 

  40. SAS 9.4 Software. https://www.sas.com/en_us/software/sas9.html.

  41. StataCorp. Stata statistical software: release 16. College Station: StataCorp LLC; 2019.

    Google Scholar 

  42. James GD, Donaldson GC, Wedzicha JA, Nazareth I. Trends in management and outcomes of COPD patients in primary care, 2000–2009: a retrospective cohort study. NPJ Prim Care Resp Med. 2014;24:1–7 (Nature Publishing Group).

    Article  Google Scholar 

  43. US population by year, race, age, ethnicity, & more. USAFacts. 2023. https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/.

  44. American Lung Association. Tobacco Trends Brief. https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-tobacco-trends.

  45. Celi A, Latorre M, Paggiaro P, Pistelli R. Chronic obstructive pulmonary disease: moving from symptom relief to mortality reduction. Ther Adv Chronic Dis. 2021;12:20406223211014028.

    Article  PubMed Central  Google Scholar 

  46. Stuart B, Doshi JA, Briesacher B, Wrobel MV, Baysac F. Impact of prescription coverage on hospital and physician costs: a case study of medicare beneficiaries with chronic obstructive pulmonary disease. Clin Ther. 2004;26:1688–99.

    Article  PubMed  Google Scholar 

  47. Quint JK, Montonen J, Esposito DB, He X, Koerner L, Wallace L, et al. Effectiveness and safety of COPD maintenance therapy with tiotropium/olodaterol versus LABA/ICS in a US claims database. Adv Ther. 2021;38:2249–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Almagro P, Soriano JB. Underdiagnosis in COPD: a battle worth fighting. Lancet Respir Med Elsevier. 2017;5:367–8.

    Article  Google Scholar 

  49. Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, et al. Determinants of underdiagnosis of COPD in national and international surveys. Chest. 2015;148:971–85.

    Article  PubMed  Google Scholar 

  50. Syamlal G. Medical expenditures attributed to asthma and chronic obstructive pulmonary disease among workers — United States, 2011–2015. MMWR Morb Mortal Wkly Rep. 2020;69. https://www.cdc.gov/mmwr/volumes/69/wr/mm6926a1.htm.

  51. Patel MR, Press VG, Gerald LB, Barnes T, Blake K, Brown LK, et al. Improving the affordability of prescription medications for people with chronic respiratory disease. An official American Thoracic Society Policy Statement. Am J Respir Crit Care Med. 2018;198:1367–74.

    Article  PubMed  Google Scholar 

  52. Reynolds EL, Burke JF, Banerjee M, Kerber KA, Skolarus LE, Magliocco B, et al. Association of out-of-pocket costs on adherence to common neurologic medications. Neurology. 2020;94:e1415–26.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Consumer reports survey: one in four people who regularly take meds hit with sticker shock at the pharmacy. PRWeb. https://www.prweb.com/releases/2017/05/prweb14337582.htm.

  54. Khot UN, Vogan ED, Militello MA. Nitroprusside and isoproterenol use after major price increases. N Eng J Med. 2017;377:594–5 (Massachusetts Medical Society).

    Article  Google Scholar 

  55. Biggers A, Shi Y, Charlson J, Smith EC, Smallwood AJ, Nattinger AB, et al. Medicare D subsidies and racial disparities in persistence and adherence with hormonal therapy. JCO. 2016;34:4398–404 (Wolters Kluwer).

    Article  Google Scholar 

  56. Zafari Z, Sin DD, Postma DS, Löfdahl C-G, Vonk J, Bryan S, et al. Individualized prediction of lung-function decline in chronic obstructive pulmonary disease. Can Med Assoc J. 2016;188:1004.

    Article  Google Scholar 

  57. Yu T, Fain K, Boyd CM, Singh S, Weiss CO, Li T, et al. Benefits and harms of roflumilast in moderate to severe COPD. Thorax. 2014;69:616–22.

    Article  PubMed  Google Scholar 

  58. Guerra B, Gaveikaite V, Bianchi C, Puhan MA. Prediction models for exacerbations in patients with COPD. Eur Respir Rev. 2017;26: 160061.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Yebyo HG, Braun J, Menges D, Riet G ter, Sadatsafavi M, Puhan MA. Personalising add-on treatment with inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a benefit–harm modelling study. Lancet Dig Health. Elsevier; 2021;0. https://www.thelancet.com/journals/landig/article/PIIS2589-7500(21)00130-8/abstract.

  60. Stagnitti MN, Machlin SR, Zodet MW, Saleska E. Methodology Report #32: design, methods, and field results of the Medical Expenditure Panel Survey Medical Provider Component (MEPS MPC) including the Medical Organizations Survey (MOS)—2016 Data Year. Agency for Healthcare Research and Quality, Rockville, Md.; 2018. https://meps.ahrq.gov/data_files/publications/mr32/mr32.shtml.

  61. Pagano E, Petrelli A, Picariello R, Merletti F, Gnavi R, Bruno G. Is the choice of the statistical model relevant in the cost estimation of patients with chronic diseases? An empirical approach by the Piedmont Diabetes Registry. BMC Health Serv Res. 2015;15:582.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Onukwugha E, McRae J, Kravetz A, Varga S, Khairnar R, Mullins CD. Cost-of-illness studies: an updated review of current methods. Pharmacoeconomics. 2016;34:43–58.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, 220 N. Arch street, 12th Floor, Baltimore, MD, 21201, USA

    Chintal H. Shah, Linda Wastila, Eberechukwu Onukwugha, Mathangi Gopalakrishnan & Zafar Zafari

  2. Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Robert M. Reed

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Correspondence to Chintal H. Shah.

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No funding was received for this work.

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Authors declare no conflict of interests.

Ethics Approval

Not applicable as publicly available de-identified data provided by AHRQ.

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Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code Availability

The codes during the current study are available from the corresponding author on reasonable request.

Authors’ Contributions

CHS developed the idea, designed the analytical model, performed statistical analyses, and wrote the first version of the manuscript. ZZ, RMR, LW, EO, and MG helped develop the research idea, provided supervision and clinical and methodological insights, and helped with writing the first version of the manuscript. All authors contributed to the manuscript in writing and development.

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Shah, C.H., Reed, R.M., Wastila, L. et al. Direct Medical Costs of COPD in the USA: An Analysis of the Medical Expenditure Panel Survey 2017–2018. Appl Health Econ Health Policy 21, 915–924 (2023). https://doi.org/10.1007/s40258-023-00814-8

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