Healthcare Service Usage and Costs for Elderly Patients with Obstructive Lung Disease.
comorbidities
healthcare costs
healthcare service usage
obstructive lung disease
Journal
International journal of chronic obstructive pulmonary disease
ISSN: 1178-2005
Titre abrégé: Int J Chron Obstruct Pulmon Dis
Pays: New Zealand
ID NLM: 101273481
Informations de publication
Date de publication:
2020
2020
Historique:
received:
05
08
2020
accepted:
09
11
2020
entrez:
30
12
2020
pubmed:
31
12
2020
medline:
29
6
2021
Statut:
epublish
Résumé
The worldwide prevalence of obstructive lung disease (OLD) is increasing, especially among people >65 years old, and nearly three in four adults with OLD have two or more comorbid conditions. This study describes the impact of such comorbidities on the healthcare service usage and related costs in a country with universal health coverage, basing on a large cohort of elderly patients with OLD and employing real-world data. We carried out a retrospective cohort study on a large population of elderly (age >64 years) patients with OLD served by a Local Health Unit in northern Italy. Their comorbidities were assessed using the clinical diagnoses assigned by the Adjusted Clinical Group (ACG) system to individual patients by combining different information flows. Correlations between number of comorbidities and total annual healthcare service usage and costs were examined with Spearman's test. Regression models were applied to analyze the associations between the above-mentioned variables, adjusting for age and sex. All types of healthcare service usage (access to emergency care; number of outpatient visits; number of hospital admissions) and pharmacy costs increased significantly with the number of comorbidities. Average total annual costs increased steadily with the number of comorbidities, ranging from € 1158.84 with no comorbidities up to € 9666.60 with 6 comorbidities or more. Poisson regression analyses showed an independent association between the number of comorbidities and the use of every type of healthcare service. These results based on real-world data provide evidence that the burden of care for OLD patients related to their comorbidities is independent of and in addition to the burden related to OLD alone and is strongly dependent on the number of comorbidities, suggesting a holistic approach to multimorbid patients with OLD is the most sound public health strategy.
Sections du résumé
Background
The worldwide prevalence of obstructive lung disease (OLD) is increasing, especially among people >65 years old, and nearly three in four adults with OLD have two or more comorbid conditions. This study describes the impact of such comorbidities on the healthcare service usage and related costs in a country with universal health coverage, basing on a large cohort of elderly patients with OLD and employing real-world data.
Methods
We carried out a retrospective cohort study on a large population of elderly (age >64 years) patients with OLD served by a Local Health Unit in northern Italy. Their comorbidities were assessed using the clinical diagnoses assigned by the Adjusted Clinical Group (ACG) system to individual patients by combining different information flows. Correlations between number of comorbidities and total annual healthcare service usage and costs were examined with Spearman's test. Regression models were applied to analyze the associations between the above-mentioned variables, adjusting for age and sex.
Results
All types of healthcare service usage (access to emergency care; number of outpatient visits; number of hospital admissions) and pharmacy costs increased significantly with the number of comorbidities. Average total annual costs increased steadily with the number of comorbidities, ranging from € 1158.84 with no comorbidities up to € 9666.60 with 6 comorbidities or more. Poisson regression analyses showed an independent association between the number of comorbidities and the use of every type of healthcare service.
Conclusion
These results based on real-world data provide evidence that the burden of care for OLD patients related to their comorbidities is independent of and in addition to the burden related to OLD alone and is strongly dependent on the number of comorbidities, suggesting a holistic approach to multimorbid patients with OLD is the most sound public health strategy.
Identifiants
pubmed: 33376316
doi: 10.2147/COPD.S275687
pii: 275687
pmc: PMC7755892
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3357-3366Informations de copyright
© 2020 Buja et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
Prev Chronic Dis. 2017 Apr 13;14:E31
pubmed: 28409741
Lancet. 2012 Jul 7;380(9836):37-43
pubmed: 22579043
BMC Public Health. 2020 Jan 14;20(1):53
pubmed: 31937272
Eur Respir Rev. 2013 Dec;22(130):454-75
pubmed: 24293462
Respir Investig. 2015 Nov;53(6):249-58
pubmed: 26521102
Int J Chron Obstruct Pulmon Dis. 2014 Aug 27;9:871-88
pubmed: 25210449
Int J Chron Obstruct Pulmon Dis. 2016 Oct 26;11:2681-2690
pubmed: 27822030
Am J Respir Crit Care Med. 2013 Apr 1;187(7):728-35
pubmed: 23392440
Lancet. 2017 Sep 16;390(10100):1211-1259
pubmed: 28919117
N Engl J Med. 2000 Jul 6;343(1):8-15
pubmed: 10882763
Respir Med. 2004 Dec;98(12):1207-13
pubmed: 15588042
COPD. 2015 Aug;12(4):381-9
pubmed: 25415366
Respir Res. 2011 Jan 13;12:7
pubmed: 21232087
Respir Med. 2013 Sep;107(9):1376-84
pubmed: 23791463
Int Arch Allergy Immunol. 2019;179(4):273-280
pubmed: 30999310
Respirology. 2015 Nov;20(8):1160-71
pubmed: 26374280
Healthcare (Basel). 2019 Mar 01;7(1):
pubmed: 30832210
Eur Respir J. 2008 Oct;32(4):962-9
pubmed: 18579551
Heart Lung. 1995 Nov-Dec;24(6):427-35
pubmed: 8582818
J Am Coll Cardiol. 2002 Jun 19;39(12):1909-16
pubmed: 12084587
N Engl J Med. 1991 Jul 25;325(4):221-5
pubmed: 2057022
Asthma Res Pract. 2017 Jan 6;3:1
pubmed: 28078100
Int J Chron Obstruct Pulmon Dis. 2018 Jan 11;13:275-285
pubmed: 29391785
Int J Chron Obstruct Pulmon Dis. 2017 Feb 23;12:735-744
pubmed: 28260880
Respir Med. 2010 May;104(5):697-704
pubmed: 19954941
J Investig Allergol Clin Immunol. 2006;16(1):44-50
pubmed: 16599248
PLoS One. 2014 Jul 21;9(7):e102149
pubmed: 25048354
Respir Res. 2010 Sep 10;11:122
pubmed: 20831787
PLoS One. 2013 May 10;8(5):e62985
pubmed: 23675448