Pneumologie 2016; 70 - P32
DOI: 10.1055/s-0036-1584636

The effect of comorbidities and respiratory symptoms on healthcare costs in patients with COPD. Results from the COSYCONET cohort

ME Wacker 1, RA Jörres 2, H Schulz 1, J Heinrich 1, S Karrasch 1, A Karch 3, A Koch 3, R Leidl 1, C Vogelmeier 4, R Holle 1
  • 1Helmholtz Zentrum München GmbH, München
  • 2Ludwig-Maximilians-Universität München, München
  • 3Medizinische Hochschule Hannover, Hannover
  • 4Universität Marburg, Marburg, University Gießen and Marburg Lung Center (UGMLC)

Background: Healthcare costs in patients with COPD are rising with increasing disease severity. This study investigates the role of comorbidities and symptoms as additional drivers of costs based on data from the COSYCONET COPD cohort.

Methods: Healthcare costs for the year 2012 were calculated from self-reported data on healthcare utilization from the baseline examination of patients with physician-diagnosed COPD in GOLD grade 1 – 4.

From a list of 33 possible self-reported comorbidities, 26 with a prevalence > 3% and information on cough, dyspnea (mMRC grade), and sputum were used as predictors of costs in generalized linear regression models. The final model comprised the top-10 comorbidities and symptoms with significant effects. Additional models also included interaction terms. Age, sex, education, smoking status, and BMI were considered as confounders.

Results: Unadjusted mean annual healthcare costs of 2,139 COPD patients (mean age 65 years, 61% males) were € 6,725 [SD 9,424]. Higher COPD grade was significantly associated with increased costs (+23%, +63%, +85% for grades 2,3,4 compared to grade 1, all p < 0.003). Higher levels of dyspnea significantly increased costs (+24%, +65%, +206% for mMRC grades 2,3,4). Cough and sputum did not have significant effects.

A history of stroke showed the strongest association with costs (+57%), but osteoporosis (+41%), psychiatric disorders (+35%), peripheral polyneuropathy (+30%), heart disease (+29%), sleep apnea (+25%), cancer (+23%), migraine (+18%), cholelithiasis/cholecystitis (+16%), and peptic ulcer (+14%) were also significantly associated with higher costs.

When studying interactions, higher COPD grade, a high number of comorbidities, and a high degree of dyspnea were significantly associated with an increase in costs, but interactions between these predictors showed sub-additive effects and reduced their independent cost driving effects.

Discussion: Besides higher COPD grade, dyspnea and several comorbidities are important drivers of healthcare cost in patients with COPD. Knowledge about predictors of costs may support the targeting of appropriate interventions to reduce the economic burden of COPD.