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Burden of Concomitant Asthma and COPD in a Medicaid Population

Dongyi Du, MS, Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Email ddu001@umaryland.edu; Manabu O. Akazawa, PhD, University of North Carolina at Chapel Hill, Email: manabu.o.akazawa@gsk.com; Christopher. M. Blanchette, PhD, GlaxoSmithKline, Inc., christopher.m.blanchette@gsk.com; Jingshu Wang, PhD, University of Maryland School of Pharmacy, Email: jwang1@rx.umaryland.edu; Douglas W. Mapel, MD, MPH, Lovelace Clinic Foundation, Email: dmapel@comcast.net; Anand Dalal, Ph.D., M.B.A., GlaxoSmithKline, Inc., Email: Anand.a.dalal@gsk.com; Steven M Scharf MD PhD, University of Maryland, Baltimore, Email: sscharf@medicine.umaryland.edu

fshaya{at}rx.umaryland.edu

Abstract

Background: Asthma and COPD can significantly affect patients and pose a substantial economic burden for both patients and managed care plans. This study compares utilization outcomes in patients with asthma, COPD or co-occurring asthma and COPD in a Medicaid population and assesses the incremental burden of COPD in patients with asthma.

Methods: We queried medical claims of Medicaid patients aged 40-64 years with asthma and/or COPD filed between 1/1/01 and 12/31/03, from encounter data. COPD patients were identified based on at least one claim with ICD-9 codes 491, 492, 496, and asthma patients on the basis of ICD-9 code 493 as diagnosis. We analyzed annual utilization and cost of hospitalizations, physician, and outpatient services attributable to asthma and/or COPD.

Results: The analysis included a total of 3,072 asthma, 3,455 COPD and 2,604 COPD/asthma patients. COPD/asthma co-occurring disease has higher utilization of any service type than either disease alone. Compared with asthma patients, COPD patients were 16% and 51% more likely to use physician (OR=1.16, 95% CI: 1.01-1.34) and inpatient services (OR=1.51 95% CI: 1.31-1.74), respectively; and 60% less likely to use outpatient services (OR=0.40 95% CI: 0.35-0.46). Compared with asthma patients, COPD patients, and COPD/asthma co-occurring patients cost 50% (OR=1.50, 95% CI: 1.3-1.74) and 5 times (OR=5.25, 95% CI: 4.59-6.02) more for total medical services respectively.

Conclusion: Our data suggest that patients with COPD and co-occurring COPD/asthma were sicker and used more medical services than asthma patients. The incremental burden of COPD to patients with asthma is significant.

Key Words: Asthma • COPD • Medical utilization • Medicaid