Exploring the utilization of healthcare resources in elderly patients with COPD

Abstract

Background: Chronic obstructive pulmonary disease (COPD) remains a major health problem worldwide (1) and the prevalence of COPD continues to increase (2, 3). It is a major cause of multimorbidity and mortality in Norway (4) and the healthcare utilization by COPD- patients is expected to increase in the future (5). To effectively allocate healthcare resources, it is necessary to have knowledge about how the resources are utilized (6). The present study aimed to describe and explore how elderly patients with COPD utilize healthcare in the health region of South-East in Norway. And to isolate the effect of having COPD by comparing this group of patients with the general population.

Methods: This cross-sectional study was based and conducted on data from three different Norwegian registers (KUHR, NPR and DSF). The study sample consisted of COPD-patients aged 66-105 years old, who had at least one contact regarding COPD with either the primary- or specialist healthcare sector between 2012 and 2016. Descriptive analyses were used to describe the sample of COPD-patients and the prevalence of type of contact they generated. Costs related to treatment in the specialist healthcare sector was based on DRG-codes and regression analyses were conducted to investigate the association between number of additional diagnoses, age, sex, and the costs related to treatment.

Results: There was a total of 35 185 COPD-patients registered in either the primary- or specialist healthcare sector from 2012 to 2016. This equals on average 6 442 and 2 789 unique COPD-patients registered in KUHR and NPR each year, respectively. The distribution between the sexes were equal, with 44,5% males. Mean birthyear was 1940 and average age was about 74 years old for both sexes. COPD-patients generated on average more than 13 events in the primary healthcare sector and more than five events in specialist healthcare sector, each year. The total cost for treating COPD-patients in the specialist healthcare sector in 2016 exceeded 1.1 billion and the average cost of treatment per COPD-patient in the specialist healthcare sector was 82 247 NOK in 2015. The average cost for females was 5865 NOK lower than it was for males and the average cost per patient increased with 5 293 NOK for each additional diagnose that was added. The costs were more than 3.5 times higher for COPD-patients than it was for the general population. Concentration curves reveals that 20% of the COPD-patients in KUHR are accountable for almost half of the events, and 20% of the COPD-patients in NPR are accountable for 60% of the events. The top 30% of COPD-patients who utilize most healthcare resources have a mean cost of treatment that is almost two times higher than the mean cost of treatment for the average COPD-patient.

Conclusion: The number of events COPD-patients generates in the primary- and specialist healthcare sector and the high costs related to treatment in hospitals confirms that COPD- patients imposes significant social and economic burden on patients and society. The results indicates that future research and allocation should focus on COPD-patients with multimorbidity and the share of COPD-patients that utilize the most healthcare resources.