Determinants of elevated healthcare utilization in patients with COPDReport as inadecuate

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Respiratory Research

, 12:7

First Online: 01 December 2011Received: 14 October 2010Accepted: 13 January 2011


BackgroundChronic obstructive pulmonary disease COPD imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system.

MethodsThree-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life HRQoL indices were obtained using validated questionnaires among a subsample of 177 patients.

ResultsHealthcare utilization was 3.4-fold higher among COPD patients compared with controls p < 0.001. The -most-costly- upper 25% of COPD patients n = 98 consumed 63% of all costs. Multivariate analysis revealed that independent determinants of being in the -most costly- group were OR; 95% CI: age-adjusted Charlson Comorbidity Index 1.09; 1.01 - 1.2, history of: myocardial infarct 2.87; 1.5 - 5.5, congestive heart failure 3.52; 1.9 - 6.4, mild liver disease 3.83; 1.3 - 11.2 and diabetes 2.02; 1.1 - 3.6. Bivariate analysis revealed that cost increased as HRQoL declined and severity of airflow obstruction increased but these were not independent determinants in a multivariate analysis.

ConclusionComorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the -most costly- patients.

AbbreviationsBMIbody mass index

CCICharlson comorbidity index

CHSClalit Health Services

COPDchronic obstructive pulmonary disease

FEV1Forced expired volume in one second

GOLDGlobal initiative for obstructive lung disease

HRQoLHealth related quality of life

HUIHealth Utilities Index

OSAObstructive sleep apnea

PSQIPittsburgh Sleep Quality Index

SGRQSt Georges Respiratory Questionnaire.

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Author: Tzahit Simon-Tuval - Steven M Scharf - Nimrod Maimon - Barbara J Bernhard-Scharf - Haim Reuveni - Ariel Tarasiuk


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