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J Gen Intern Med. 2018 Sep;33(9):1528-1535. doi: 10.1007/s11606-018-4406-x. Epub 2018 Apr 2.

The Impact of Care Specialty on Survival-Adjusted Medical Costs of COPD Patients After a Hospitalization: a longitudinal analysis.

Author information

1
Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
2
Division of Respiratory Medicine, Department of Medicine, The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
3
Institute for Heart and Lung Health, Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, 7th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
4
Institute for Heart and Lung Health, Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, 7th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Mark.Fitzgerald@vch.ca.
5
Centre for Clinical Epidemiology and Evaluation, University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. Mark.Fitzgerald@vch.ca.
6
UBC Division of Respiratory Medicine, Department of Medicine, The Lung Centre, Gordon and Leslie Diamond Health Care Centre, 7th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. Mark.Fitzgerald@vch.ca.
7
Centre for Clinical Epidemiology and Evaluation, University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.

Abstract

BACKGROUND:

Little is known about the impact of care provider's specialty on the medical costs of COPD patients over time.

OBJECTIVE:

To compare the long-term medical costs between newly hospitalized COPD patients whose post-discharge care was initiated by a pulmonary specialist versus by a general practitioner.

DESIGN:

Retrospective matched cohort study.

PARTICIPANTS:

We identified patients with an incident COPD-related hospitalization from the administrative health database (January 1, 1996, to December 31, 2012) of British Columbia, Canada.

MAIN MEASURES:

Patients were categorized as receiving specialist care or primary care within the first 90 days after discharge from an incident COPD-related hospitalization. Using propensity scores, we matched each patient who initially received specialist care to a patient who received primary care based on demographics, COPD severity, comorbidity, and admission time. A survival-adjusted, multi-part generalized linear model was used to estimate direct medical costs (in 2015 Canadian dollars, [$], including inpatient, outpatient, pharmacy, and community care costs) as overall and as COPD-specific and comorbidity-related costs over the following 5 years.

KEY RESULTS:

The sample included 7710 patients under each group. The initial specialist-care recipients had a modestly higher 5-year survival than the generalist-care recipients (0.564 [95% CI 0.535, 0.634] vs 0.555 [95% CI 0.525, 0.625]; P < .001). Meanwhile, the former incurred $2809 higher all-cause medical costs over 5 years compared to the latter (95% CI $2343, $2913; P < .001), mainly driven by higher medication costs (difference $1782 [95% CI $1658, $1830]; P < .001) particularly related to COPD medications ($1170 [95% CI $1043, $1225]; P < .001). Specialist care recipients also incurred higher costs of COPD-related hospitalization ($1144 [95% CI $650, $1221]; P < .001).

CONCLUSIONS:

Compared to generalist care, specialist care following COPD hospitalization is slightly more expensive, mainly driven by medication costs especially COPD-specific medications. Future studies should compare differences in health-related quality of life and COPD functional status.

KEYWORDS:

COPD; healthcare costs; longitudinal analysis; specialty of care

PMID:
29611088
PMCID:
PMC6109016
[Available on 2019-09-01]
DOI:
10.1007/s11606-018-4406-x

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