Acute Exacerbations of COPD in the United States: Inpatient Burden and Predictors of Costs and Mortality

The University of Arizona, College of Pharmacy, Center for Health Outcomes and PharmcoEconomic Research, Tucson, Arizona 85721, USA.
COPD Journal of Chronic Obstructive Pulmonary Disease (Impact Factor: 2.67). 03/2012; 9(2):131-41. DOI: 10.3109/15412555.2011.650239
Source: PubMed


Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalizations in the United States and the major cost driver of COPD. This study determined the national inpatient burden of AECOPD and assessed the association of co-morbidities and hospital characteristics with inpatient costs and mortality. Discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample for 2006 was utilized. Outcomes of costs and mortality were assessed for AECOPD hospitalizations in cases ≥40 years of age. Multivariate regression analyses using a generalized linear model framework were conducted to determine predictors of inpatient costs and mortality controlling for patient demographics, primary payer, co-morbidity index, length of stay, hospital region, mechanical ventilation, and admission period. Overall, 1,254,703 hospitalizations for AECOPD were observed with mean costs of $9545(±12,700) and total costs of $11.9 billion. In-hospital mortality was 4.3% (N = 53,748). Discharges averaged 70.6 (±11.9) years of age. The majority were female (52.8%) and of white race (83.6% of reported race). Several co-morbidities were significantly associated with both costs and mortality (p < 0.001): acute myocardial infarction; congestive heart failure; cerebrovascular disease; lung cancer; cardiac arrhythmias; pulmonary circulation disorders; and weight loss. Significantly higher costs (p < 0.001) were associated with large and urban hospitals. The importance of co-morbidities in AECOPD is indicated in their association with prognosis and inpatient costs. Future research should determine if better management of these conditions can favorably impact the COPD disease burden.

Download full-text


Available from: Grant H Skrepnek,
  • Source
    • "COPD poses a significant economic burden on society. The largest proportion of the disease-related cost is attributable to a small percentage of patients (those severe cases) because most expenditure is associated with hospitalizations by Acute Exacerbations of COPD (AECOPD) [6]. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines define a COPD exacerbation as " an event in the natural course of the disease characterized by a change in the patient's baseline dyspnea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in medication in a patient with underlying COPD " [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease of the lung with a great prevalence and a remarkable socio-economic impact on patients and health systems. Early detection of exacerbations could diminish the adverse effects on patients' health and cut down costs burdened on patients with COPD. A group of 16 patients were telemonitored at home using a novel electronic daily symptoms questionnaire during a 6-months field trial. Recorded data were used to train and validate a Probabilistic Neural Network (PNN) classifier in order to enable the automatic prediction of exacerbations. The proposed system was able to predict COPD exacerbations early with a margin of 4.8±1.8 days (average ± SD). Detection accuracy was 80.5% (33 out of 41 exacerbations were early detected); 78.8% (26 out of 33) of theses detected events were reported exacerbation and 87.5% (7 out of 8) were unreported episodes. The proposed questionnaire and the designed automatic classifier could support the early detection of COPD exacerbations of benefit to both physicians and patients.
    Bio-medical materials and engineering 09/2014; 24(6):3825-32. DOI:10.3233/BME-141212 · 1.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess visual acuity (VA) and 2 questionnaires of health-related quality of life--the Visual Function 14 (VF-14) index and the Medical Outcomes Study Short Form 36 Health Survey (SF-36)--as instruments for capturing clinically important changes after cataract surgery. Prospective, observational study. Four thousand three hundred fifty-six consecutive patients attending ophthalmologic clinics in 17 hospitals in preparation for cataract surgery were recruited. Clinical data were collected in the visit before the intervention and 6 weeks after surgery by ophthalmologists. Patients completed the questionnaires before surgery and 3 months after surgery. The VF-14 and SF-36 questionnaire results obtained before surgery and 3 months after the procedure and VA before the procedure and 6 weeks afterward. Positive mean changes in VA (+0.47) and VF-14 results (+24.03) indicated significant improvements after cataract surgery that were not reflected in changes in SF-36 domains (from 1.86 to 5.62). Responsiveness parameters demonstrated large changes in VA and VF-14 scores but not in SF-36 domains. The minimal clinically important differences (MCID) after surgery were 0.41 for VA and 15.57 for VF-14 results; the minimal detectable change (MDC) for VF-14 was 10.81. Visual acuity and VF-14 scores, but not SF-36 scores, are appropriate instruments for capturing clinically important changes after cataract surgery. The MCID and MDC values obtained herein, although not absolute thresholds, may aid in the interpretation of changes in VA and VF-14 scores.
    Ophthalmology 03/2009; 116(3). DOI:10.1016/j.ophtha.2008.11.020 · 6.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Daily use of azithromycin, in conjunction with the usual COPD regimen, has been found to reduce acute exacerbations in patients with moderate to severe disease.
    The Journal of family practice 07/2012; 61(7):414-6. · 0.89 Impact Factor
Show more