Cost of Chronic Obstructive Pulmonary Disease in the Emergency Department and Hospital

Abstract

Study objectives: Treatment of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) or hospital accounts for a significant portion of COPD costs. This study estimates the cost of a COPD ED or hospitalization visit in the US.

Design: This observational study utilized administrative data from 218 acute care hospitals. ED/hospital discharges for COPD (International Classification of Diseases — Ninth Revision — Clinical Modification codes 491.xx. 492.xx, 496.xx) during 2001 were identified. Costs were determined for three groups: (i) ED only; (ii) standard admission; and (iii) severe admissions (intensive care unit [ICU] or intubation). Severe admissions were stratified into: (i) ICU/no intubation; (ii) intubation/no ICU; and (iii) ICU + intubation. Mean total costs and length of stay (LOS) were calculated for each group.

Results: A total of 59 735 ED/hospital encounters were identified: 20 431 ED only, 33 210 standard admissions, and 6094 severe admissions (4456 ICU/no intubation, 496 intubation/no ICU, and 1142 ICU/intubation). ED visits had a mean cost of $US571 ± 507 (year 2001 value). Inpatient costs ranged from $US5997 (± 5752) for a standard admission to $US36 743 (± 62 886) for ICU plus intubation admissions, while LOS ranged from 5.1 days (±4.5) to 14.8 days (± 16.7), respectively. In addition, only 10% of encounters required an intubation/ICU admission, but these accounted for 34% of the cost.

Conclusion: Cost of a COPD hospitalization is substantial in the US, with one-third of those costs being associated with severe admissions, which make up only 10% of all COPD admissions. Treatments aimed at reducing hospitalizations and length of stay could result in substantial cost savings.