Clinical And Economic Burden Of Chronic Obstructive Pulmonary Disease In Veteran Patients In The United States: A Real-World Evaluation

Abstract

OBJECTIVES: To evaluate the clinical and economic burden of chronic obstructive pulmonary disease (COPD) in the U.S. veteran population. METHODS: Patients diagnosed with COPD (International Classification of Disease 9thRevision Clinical Modification [ICD-9-CM] diagnosis codes 490.xx, 491.xx, 492.xx, 494.xx, 495.xx, 496.xx) were included in this retrospective study (October 1, 2005 - May 31, 2012) conducted using the Veterans Health Administration (VHA) Medical SAS Datasets. Health care resource utilization and costs were assessed for the 12-month follow-up period. Patients' clinical and discharge statuses were examined for the 12-month baseline period. Means and standard deviations were provided for continuous variables. Numbers and percentage were provided for categorical variables. All descriptive statistical analyses were performed using SAS v9.3 software. RESULTS: Among all study patients diagnosed with COPD (772,898), major comorbidities during the baseline period included hypertension (27.9%), depressive disorder (6.72%), chronic ischemic heart disease (5.18%) and shortness of breath (4.73%). The most common medications prescribed within 60 days of disease identification were simvastatin (27.45%), lisinopril (20.63%), omeprazole (19.47%) and aspirin (12.19%). In the 12-month follow-up period 49.61% of patients were prescribed short-acting b-agonists (SABAs) while only 60 patients were prescribed long-acting b-agonists (LABAs). Outpatient visits (99.75%) occurred more frequently than inpatient visits (22.28%). Inpatient ($8,420), outpatient ($8,584) and pharmacy costs ($1,746) combined for a total expenditure of $18,750. CONCLUSIONS: Patients were prescribed simvastatin, lisinopril and omeprazole more often within 3 months after disease identification than other medications. Within 1-year postdiagnosis, SABAs were prescribed more often than LABAs as a treatment for COPD.