Costs of COPD exacerbations in the emergency department and inpatient setting.

BACKGROUND: Exacerbations of COPD contribute to lung function decline and reduced quality of life. Treatment of exacerbations in the hospital setting is costly, but information concerning the component cost drivers of this care is scarce. Our objective was to describe and characterize costs of COPD care in the hospital setting.
METHODS: Administrative data from 602 hospitals were used to calculate 2008 costs for COPD-related emergency department (ED) visits, simple inpatient admissions and complex admissions (categorized as intubation/no intensive care, intensive care/no intubation, or intensive care/intubation) among COPD patients' age ≥ 40 years. Inpatient mortality, length of stay (LOS), and readmission rates in 2005-2008 were also calculated.
RESULTS: Mean 2008 costs were $647 (SD $445) for ED visits (n = 24,617), $7242 ($7987) for simple admissions (n = 42,734), and $20,757 ($41,370) for complex admissions (n = 4142). Intensive care/intubation admissions incurred the highest costs ($44,909 [SD, $80,351]; n = 838). Complex admissions accounted for 5.8% of hospital-based COPD care in 2008, but 20.9% of costs. Mean LOS ranged from 4.5 days (SD 3.3) for simple admissions to 16.0 days (16.7) for intensive care/intubation admissions. Death occurred in 0.9% of simple admissions, 10.3% of all complex admissions, and 26.5-39.1% of admissions involving intubation. Readmission rates within 30-60 days for ED visits, simple admissions and complex admissions were 17.8%, 15.3% and 15.7%, respectively. From 2005 to 2008, trends in LOS were relatively flat; inflation-adjusted costs increased 4.0-5.9%.
CONCLUSIONS: Costs of hospital-based care for COPD are substantial. Admissions involving intubation or intensive care are associated with the highest costs, LOS, and mortality.