The Impact of Care Specialty on Survival-Adjusted Medical Costs of COPD Patients After a Hospitalization: a longitudinal analysis
Little is known about the impact of care provider’s specialty on the medical costs of COPD patients over time.
To compare the long-term medical costs between newly hospitalized COPD patients whose post-discharge care was initiated by a pulmonary specialist versus by a general practitioner.
Retrospective matched cohort study.
We identified patients with an incident COPD-related hospitalization from the administrative health database (January 1, 1996, to December 31, 2012) of British Columbia, Canada.
Patients were categorized as receiving specialist care or primary care within the first 90 days after discharge from an incident COPD-related hospitalization. Using propensity scores, we matched each patient who initially received specialist care to a patient who received primary care based on demographics, COPD severity, comorbidity, and admission time. A survival-adjusted, multi-part generalized linear model was used to estimate direct medical costs (in 2015 Canadian dollars, [$], including inpatient, outpatient, pharmacy, and community care costs) as overall and as COPD-specific and comorbidity-related costs over the following 5 years.
The sample included 7710 patients under each group. The initial specialist-care recipients had a modestly higher 5-year survival than the generalist-care recipients (0.564 [95% CI 0.535, 0.634] vs 0.555 [95% CI 0.525, 0.625]; P < .001). Meanwhile, the former incurred $2809 higher all-cause medical costs over 5 years compared to the latter (95% CI $2343, $2913; P < .001), mainly driven by higher medication costs (difference $1782 [95% CI $1658, $1830]; P < .001) particularly related to COPD medications ($1170 [95% CI $1043, $1225]; P < .001). Specialist care recipients also incurred higher costs of COPD-related hospitalization ($1144 [95% CI $650, $1221]; P < .001).
Compared to generalist care, specialist care following COPD hospitalization is slightly more expensive, mainly driven by medication costs especially COPD-specific medications. Future studies should compare differences in health-related quality of life and COPD functional status.
KEY WORDSCOPD specialty of care healthcare costs longitudinal analysis
WC had full access to all of the data in the study and takes responsibility for the content of the manuscript, including the integrity of the data and the accuracy of the data analysis. WC, JMF, DS, and MS conceived and designed the study. WC analyzed the data and wrote the first draft of the manuscript. WC, JMF, DS, and MS contributed to the interpretation of the data and clinical inputs. All authors were involved in the revision of the manuscript for important intellectual content and approved the final version to be published.
This study was funded by the Canadian Respiratory Research Network (CRRN). CRRN is supported by grants from the Canadian Institutes of Health Research (CIHR)-Institute of Circulatory and Respiratory Health, Canadian Lung Association (CLA)/Canadian Thoracic Society (CTS), British Columbia Lung Association, and Industry Partners Boehringer-Ingelheim Canada Ltd, AstraZeneca Canada Inc., and Novartis Canada Ltd. Funding for training of postdoctoral student and new investigators within the network was supported by the above funding Sponsors and as well by GlaxoSmithKline Inc. The funders had no role in the study design, data collection and analysis, or preparation of the manuscript. Dr. Sadatsafavi receives salary support from Michael Smith Foundation for Health Research and Canadian Institutes of Health Research.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interests.
- 1.Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2017. https://doi.org/10.1164/rccm.201701-0218PP.
- 3.The Human and Economic Burden of COPD - A Leading Cause of Hospital Admission in Canada | Canadian Respiratory Guidelines. http://www.respiratoryguidelines.ca/the-human-and-economic-burden-of-copd-a-leading-cause-of-hospital-admission-in-canada. Accessed 2 Feb 2018.
- 4.Wier LM, Elixhauser A, Pfuntner A, Au DH. Overview of Hospitalizations among Patients with COPD, 2008: Statistical Brief #106. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. http://www.ncbi.nlm.nih.gov/books/NBK53969/. Accessed 2 Feb 2018.
- 5.World Health Organization. Burden of COPD. WHO. http://www.who.int/respiratory/copd/burden/en/. Accessed 2 Feb 2018.
- 7.Ford ES, Murphy LB, Khavjou O, Giles WH, Holt JB, Croft JB. TOtal and state-specific medical and absenteeism costs of copd among adults aged ≥ 18 years in the united states for 2010 and projections through 2020. Chest 2015;147(1):31–45. https://doi.org/10.1378/chest.14-0972.CrossRefPubMedGoogle Scholar
- 10.Pothirat C, Liwsrisakun C, Bumroongkit C, Deesomchok A, Theerakittikul T, Limsukon A. Comparative study on health care utilization and hospital outcomes of severe acute exacerbation of chronic obstructive pulmonary disease managed by pulmonologists vs internists. Int J Chron Obstruct Pulmon Dis 2015;10:759–766. https://doi.org/10.2147/COPD.S81267.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Diaz-Fuentes G, Lakshmi V, Blum S, Sy S, Escalera E. Chronic Obstructive Pulmonary Disease: Comparison of Care by Specialists and Generalists in an Inner-City Hospital. Internet J Pulm Med. 2004;5(1). http://ispub.com/IJPM/5/1/12172. Accessed 2 Feb 2018.
- 12.Bourbeau J, Sebaldt RJ, Day A, et al. Practice patterns in the management of chronic obstructive pulmonary disease in primary practice: The CAGE study. Can Respir J J Can Thorac Soc 2008;15(1):13–19.Google Scholar
- 15.Government of Canada SC. Population by sex and age group, by province and territory (Number, both sexes). http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo31a-eng.htm. Published September 26, 2014. Accessed 2 Feb 2018.
- 16.British Columbia Ministry of Health [creator]. Consolidation File (MSP Registration & Premium Billing). Population Data BC[publisher]. Data Extract. MOH. 2014. Available at: http://www.popdata.bc.ca/data. Accessed 2 Feb 2018.
- 17.BC Vital Statistics Agency [creator]. Vital Statistics Deaths. Population Data BC [publisher]. Data Extract. BC Vital Statistics Agency. 2014. Available at: http://www.popdata.bc.ca/data. Accessed Feb 2 2018.
- 18.CIHI [creator]. Discharge Abstract Database (Hospital Separations). Population Data BC [publisher]. Data Extract. MOH. 2014. Available at: http://www.popdata.bc.ca/data. Accessed 2 Feb 2018.
- 19.M British Columbia Ministry of Health [creator]. Medical Services Plan (MSP) Payment Information File. Population Data BC [publisher]. Data Extract. MOH. 2014. Available at: http://www.popdata.bc.ca/data. Accessed 2 Feb 2018.
- 20.British Columbia Ministry of Health [creator]. PharmaNet. BC Ministry of Health [publisher]. Data Extract. Data Stewardship Committee. 2013. Available at: http://www.popdata.bc.ca/data. Accessed 2 Feb 2018.
- 21.British Columbia Ministry of Health[creator]. Home and Community Care. BC Ministry of Health [publisher].Data Extract. MOH. 2014. Available from: http://www.popdata.bc.ca/data. Accessed 2 Feb 2018.
- 22.(CIHI) CI for HI. CIHI Data Quality Study of the DAD 2009–2010 Discharge Abstract Database. https://secure.cihi.ca/estore/productFamily.htm?pf=PFC1762&lang=en&media=0. Published April 27, 2012. Accessed 2 Feb 2018.
- 26.Mapel DW, Dutro MP, Marton JP, Woodruff K, Make B. Identifying and characterizing COPD patients in US managed care. A retrospective, cross-sectional analysis of administrative claims data. BMC Health Serv Res 2011;11:43. https://doi.org/10.1186/1472-6963-11-43.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Poole B, Robinson S, MacKinnon M. Resource Intensity Weights and Canadian hospital costs: some preliminary data. Healthc Manag Forum Can Coll Health Serv Exec Forum Gest Soins Santé Collège Can Dir Serv Santé 1998;11(1):22–26.Google Scholar
- 31.McKendry R, Reid RJ, McGrail KM, et al. Emergency Rooms in British Columbia: A Pilot Project to Validate Current Data and Describe Users. Vancouver (BC): Centre for Health Services and Policy Research; 2002.Google Scholar
- 32.Cohen J. CHAPTER 2 - The t Test for Means. In: Cohen J, ed. Statistical Power Analysis for the Behavioral Sciences (Revised Edition). Academic Press; 1977:19–74. http://www.sciencedirect.com/science/article/pii/B9780121790608500074. Accessed 2 Feb 2018.
- 35.Health M of. Special Authority - Province of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/prescribers/special-authority#Druglist. Accessed 2 Feb 2018.
- 39.National Clinical Guideline Centre (UK). Ch 7. Managing Stable COPD. In: Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care. Royal College of Physicians (UK); 2010. https://www.ncbi.nlm.nih.gov/books/NBK65045/. Accessed 2 Feb 2018.
- 40.Health M of. Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management - Province of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/copd. Accessed 2 Feb 2018.
- 41.Services M of TI and C. Health Boundaries - Province of British Columbia. https://www2.gov.bc.ca/gov/content/data/geographic-data-services/land-use/administrative-boundaries/health-boundaries. Accessed 2 Feb 2018.
- 42.Waiting Your Turn: Wait Times for Health Care in Canada, 2016 Report. Fraser Institute. http://bit.ly/2gHMwL2?__unam=b07cbf6-15f4a7f006e-72453276-6&_ga=GA1.2.158609998.1508783358. Published November 23, 2016. Accessed 2 Feb 2018.
- 44.Gershon AS, Campitelli MA, Croxford R, et al. Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease. JAMA 2014;312(11):1114–1121. https://doi.org/10.1001/jama.2014.11432.CrossRefPubMedGoogle Scholar