Acute Care Costs of patients admitted for management of COPD exacerbations: contribution of disease severity, infection, and chronic heart failure.

Intern Med J. 2010 Feb 18. Hutchinson A, Brand C, Irving L, Roberts C, Thompson P, Campbell D. Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital.

Background: In 2003 COPD accounted for 46% of the burden of chronic respiratory disease in the Australian community. In the 65 to 74 year age group, COPD was the 6(th) leading cause of disability for males and the 7(th) for females.

Objective: To measure the influence of disease severity, COPD phenotype and co-morbidities on acute health service utilisation and direct acute care costs in patients admitted with COPD.

Methods: Prospective cohort study of 80 patients admitted to the Royal Melbourne Hospital in 2001-2002 for an exacerbation of COPD. Patients were followed for 12-months and data collected on acute care utilisation. Direct hospital costs were derived using Transition II, an activity-based costing system. Individual patient's costs were then modelled to ascertain which patient factors, influenced total direct hospital costs.

Results: Direct costs were calculated for 225 episodes of care, the median cost per admission was AU$3,124 (IQR $1,393 to $5,045). The median direct cost of acute care management per patient per year was AU$7,273 [IQR $3,957-$14,448]. In a multivariate analysis using linear regression modelling, factors predictive of higher annual costs were increasing age (p = 0.041), use of domiciliary oxygen (p = 0.008) and the presence of CHF (p = 0.006).

Conclusion: This model has identified a number of patient factors that predict higher acute care costs and awareness of these can be used for service planning to meet the needs of patients admitted with COPD.

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