Direct and Indirect Costs of Patients with Chronic Obstructive Pulmonary Disease

Autor: Yuan-Hao Kuan, 管元浩
Rok vydání: 2015
Druh dokumentu: 學位論文 ; thesis
Popis: 103
Introduction: Chronic obstructive pulmonary disease (COPD) is a common chronic lung disease which causes numerous deaths and disabilities. In accordance with the estimation of World Health Organization (WHO), 64 million people are diagnosed with COPD around the globe in 2004, and it is predicted to be the third leading cause of death in 2030. Moreover, the great mortality and morbidity resulted from COPD also incur enormous social economic burden. Many countries are aware of the importance of impact of COPD to the health care system gradually. Comparing to a plenty of economic burden research focused on COPD, there is a lack of studies in the field of discussing the cost of COPD in Taiwan. Materials and methods: In this study, the economic burden and health care utilization of COPD patients are calculated through the data of one million people’s 2011 Longitudinal Health Insurance Database of National Health Insurance Research Database (NHIRD), and a self-developed structured questionnaire. The sampling criteria for patient selection are: (1) with principal or secondary diagnosis of ICD-9-CM code in 491.xx, 492.xx or 496; (2) aged more than 40 years old; (3) at least two outpatient visits or one inpatient admission in a year; (4) exclude patients with illogical information in administrative claims. Second, the sampling criteria of structured questionnaire are: (1) identified with COPD by physicians; (2) aged more than 40 years old; (3) able to communicate and being conscious. In the part of secondary analysis based on NHIRD, 76,535 OPD or IPD visits and 11,714 COPD patients are included in this study. For the part of structured questionnaire, 39 COPD patients are recruited from a Chest Medicine Outpatient Department in a tertiary hospital in central Taiwan from July 2014 to August 2014. Result: In terms of direct medical costs, COPD patients have an average medical cost of 9,750 points in outpatient and emergency room visit, and 19,744 points in hospitalization per person per year. Patients’ mean annual extra costs beyond NHI coverage are NT$ 5,472, and other care giving costs are NT$ 32,269, and the costs of productivity loss are NT$ 1,782. Average numbers of outpatient visits, emergency room visits, hospitalization and length of stays are 6.17 times, 1.22 times, 0.31 times and 3.99 days, respectively. If the cases who didn’t use OPD or IPD services are excluded in calculating the mean of medical cost, the average OPD medical cost increases to 10,551 points, and the average IPD medical cost increases to 95,258 points. In terms of results of regression analysis, total direct medical cost was significantly correlated with gender, age, number of co-morbidity, and the use of inhaled corticosteroid (ICS). Being male,older, had more co-morbidity, and used ICS had higher medical cost.The out-of-pocket cost increases with higher hospital levels, and the number of patients who choose medical centers and private hospitals as their common place to seek medical advice is more than those who choose local, regional and public hospitals. Conclusion: Male COPD patients with age more than 70 years old are tend to have higher total medical cost as well as health utilizations, especially for patients with co-morbidity and using inhaled corticosteroid. In order to reduce the medical costs and disease burden of COPD, medical care providers are recommended to strengthen patients’ knowledge about the COPD and the proper way to inhale COPD medicines, which in turn may enhance the efficiency of intervention and delay the progression of COPD.
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