Direct costs of chronic obstructive pulmonary disease among managed care patients

Int J Chron Obstruct Pulmon Dis. 2010 Oct 5:5:341-9. doi: 10.2147/COPD.S13771.


Purpose: To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD) among commercially insured patients in the US.

Methods: In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days), emergency department (ED), standard inpatient admission, and intensive care unit (ICU) cohorts. Patient- level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated.

Results: Of the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD) annual COPD-related health care costs (2008 US$) increased across the cohorts (P < 0.001), ranging from $2003 ($3238) to $43,461 ($76,159) per patient. Medical costs comprised 96% of health care costs for the ICU cohort. Adjusted mean (SD) episode-level costs were $305 ($310) for an outpatient visit, $274 ($336) for an urgent outpatient visit, $327 ($65) for an ED visit, $9745 ($2968) for a standard admission, and $33,440 for an ICU stay.

Conclusion: Direct costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs.

Keywords: health care cost; health expenditure; lung diseases; managed care.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / economics
  • Cost Savings
  • Critical Care / economics
  • Databases as Topic
  • Drug Costs
  • Emergency Service, Hospital / economics
  • Female
  • Health Care Costs*
  • Health Expenditures*
  • Humans
  • Insurance Claim Reporting
  • Length of Stay / economics
  • Male
  • Managed Care Programs / economics*
  • Middle Aged
  • Patient Admission / economics
  • Pulmonary Disease, Chronic Obstructive / economics*
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Respiratory System Agents / economics
  • Respiratory System Agents / therapeutic use
  • Retrospective Studies
  • United States


  • Respiratory System Agents