Costs of inpatient and emergency department care for chronic obstructive pulmonary disease in an elderly Medicare population

J Med Econ. 2010;13(4):591-8. doi: 10.3111/13696998.2010.521734. Epub 2010 Sep 20.


Objective: Treatment in the hospital setting accounts for the largest portion of healthcare costs for COPD, but there is little information about components of hospital care that contribute most to these costs. The authors determined the costs and characteristics of COPD-related hospital-based healthcare in a Medicare population.

Methods: Using administrative data from 602 hospitals, 2008 costs of COPD-related care among Medicare beneficiaries age ≥ 65 years were calculated for emergency department (ED) visits, simple inpatient admissions and complex admissions (categorized as intubation/no intensive care, intensive care/no intubation, and intensive care/intubation) in a cross-sectional study. Rates of death at discharge and trends in costs, length of stay and readmission rates from 2005 to 2008 also were examined.

Main results: There were 45,421 eligible healthcare encounters in 2008. Mean costs were $679 (SD, $399) for ED visits (n = 10,322), $7,544 ($8,049) for simple inpatient admissions (n = 25,560), and $21,098 ($46,160) for complex admissions (n = 2,441). Intensive care/intubation admissions (n = 460) had the highest costs ($45,607, SD $94,794) and greatest length of stay (16.3 days, SD 13.7); intubation/no ICU admissions had the highest inpatient mortality (42.1%). In 2008, 15.4% of patients with a COPD-related ED visit had a repeat ED visit and 15.5-16.5% of those with a COPD-related admission had a readmission within 60 days. From 2005 to 2008, costs of admissions involving intubation increased 10.4-23.5%. Study limitations include the absence of objective clinical data, including spirometry and smoking history, to validate administrative data and permit identification of disease severity.

Conclusions: In this Medicare population, COPD exacerbations and related inpatient and emergency department care represented a substantial cost burden. Admissions involving intubation were associated with the highest costs, lengths of stay and inpatient mortality. This population needs to be managed and treated adequately in order to prevent these severe events.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / economics
  • Comorbidity
  • Cross-Sectional Studies
  • Drug Utilization
  • Emergency Service, Hospital / economics*
  • Emergency Service, Hospital / trends
  • Female
  • Hospital Charges / statistics & numerical data*
  • Hospital Charges / trends
  • Hospitalization / economics*
  • Hospitalization / trends
  • Humans
  • Intensive Care Units / economics
  • Intensive Care Units / trends
  • Intubation, Intratracheal / economics
  • Length of Stay / economics
  • Length of Stay / trends
  • Male
  • Medicare / statistics & numerical data*
  • Patient Readmission / economics
  • Pulmonary Disease, Chronic Obstructive / economics*
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Retrospective Studies
  • United States


  • Bronchodilator Agents