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Byng, D. ; Lutter, J. ; Wacker, M. ; Jörres, R.A.* ; Liu, X.* ; Karrasch, S. ; Schulz, H. ; Vogelmeier, C.* ; Holle, R.

Determinants of healthcare utilization and costs in COPD patients: First longitudinal results from the German COPD cohort COSYCONET.

Int. J. Chron. Obstruct. Pulmon. Dis. 14, 1423-1439 (2019)
Verlagsversion Postprint DOI
Open Access Gold
Creative Commons Lizenzvertrag
Background: In light of overall increasing healthcare expenditures, it is mandatory to study determinants of future costs in chronic diseases. This study reports the first longitudinal results on healthcare utilization and associated costs from the German chronic obstructive pulmonary disease (COPD) cohort COSYCONET. Material and methods: Based on self-reported data of 1904 patients with COPD who attended the baseline and 18-month follow-up visits, direct costs were calculated for the 12 months preceding both examinations. Direct costs at follow-up were regressed on baseline disease severity and other co-variables to identify determinants of future costs. Change score models were developed to identify predictors of cost increases over 18 months. As possible predictors, models included GOLD grade, age, sex, education, smoking status, body mass index, comorbidity, years since COPD diagnosis, presence of symptoms, and exacerbation history. Results: Inflation-adjusted mean annual direct costs increased by 5% (n.s., €6,739 to €7,091) between the two visits. Annual future costs were significantly higher in baseline GOLD grades 2, 3, and 4 (factors 1.24, 95%-confidence interval [1.07-1.43], 1.27 [1.09-1.48], 1.57 [1.27-1.93]). A history of moderate or severe exacerbations within 12 months, a comorbidity count >3, and the presence of dyspnea and underweight were significant predictors of cost increase (estimates ranging between + €887 and + €3,679, all p<0.05). Conclusions: Higher GOLD grade, comorbidity burden, dyspnea and moderate or severe exacerbations were determinants of elevated future costs and cost increases in COPD. In addition we identified underweight as independent risk factor for an increase in direct healthcare costs over time.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Schlagwörter Change Score ; Direct Costs ; Healthcare Expenditures ; Inpatient Costs ; Outpatient Costs ; Population-based
ISSN (print) / ISBN 1176-9106
e-ISSN 1178-2005
Quellenangaben Band: 14, Heft: , Seiten: 1423-1439 Artikelnummer: , Supplement: ,
Verlag Dove Medical Press
Verlagsort Albany, Auckland
Begutachtungsstatus Peer reviewed