Costs attributable to COPD in 2029 projected to ‘nearly double’ 2019 estimated costs

Key takeaways:

• The 2029 projected cost uses a 5.1% annual National Health Expenditure per capita growth rate.
• COPD-attributable cost estimates in 2019 differed by state.

In the U.S., the projected cost attributable to COPD in 2029 is $60.5 billion, which is nearly twice the 2019 estimated costs of $31.3 billion, according to findings published in CHEST.

“As Kate M. Johnson, PhD, and Kevin I. Duan, MD, note in a recent review of our paper, this study adds to the existing literature that COPD has a substantial and growing burden,” Michael F. Pollack, MS, director of global epidemiology medical evidence at AstraZeneca, told Healio. “With these updated national and state-level estimates, we hope that COPD and its burden can be elevated and part of the broader conversation regarding health care priorities.

“These data can stimulate investments in health plan transition of care programs and national quality measures specific to COPD,” Pollack continued. “As noted by Johnson and Duan, this burden will continue to grow as the U.S. population ages unless major improvements are done in prevention and management.”

In a cross-sectional, retrospective study, Pollack and colleagues evaluated 4,135 patients with COPD (mean age, 60 years; 63.2% women; 71.2% non-Hispanic white) and 86,021 individuals without COPD (mean age, 48 years; 53% women; 49.5% non-Hispanic white) to find state-specific and nationwide estimates of COPD-attributable costs in 2019 via three national data sources.

Pollack told Healio recent estimations of the general burden of COPD in the U.S. are lacking.

“One of the most cited studies of COPD burden comes from Ford and colleagues in 2015, which used data from 2010 to provide projections through 2020,” he said.

Because Ford has been widely cited, Pollack said the current study sought to update Ford’s approach using more recent U.S. Census Bureau national population projections to determine how national medical costs attributable to COPD will change by 2029.

In the group with COPD, 17.2% had concurrent coronary heart disease, whereas only 4.4% of those without COPD had this condition. Similarly, more individuals from the cohort with vs. without COPD had concurrent hypertension (53.3% vs. 25.8%), dyslipidemia (41.9% vs. 18.9%), mental health and/or substance misuse issues (29.3% vs. 13%), arthritis (33% vs. 10.5%) and asthma (31.3% vs. 5%).

Following adjustment for demographic characteristics and 19 concurrent conditions (both related and unrelated to COPD), researchers found an estimate of $31.3 billion for COPD-attributable medical costs in 2019. Further, the national average per patient was $1,795 in excess costs related to COPD.

When divided by sex, women had a higher COPD-attributable medical cost amount than men ($17.1 billion vs. $14.2 billion).

The age group with the highest COPD-attributable medical cost amount was the 65 years or older cohort at $17.4 billion.

Cost estimates in 2019 differed by state. Reflecting the overall population size of these states, Florida had the highest COPD-attributable medical cost estimate at $3.1 billion, whereas Washington, D.C., had the lowest estimate at $41.59 million.

Other states with high cost estimates included California at $2.42 billion and Texas at $2.35 billion. In contrast, Alaska and Wyoming had low cost estimates at $44.85 million and $47.27 million, respectively.

On a per-patient basis, North Dakota, South Dakota and Minnesota appeared to have the highest excess costs per patient, whereas Utah, Washington, D.C., and Hawaii had the lowest costs per patient.

Based on payer type, individuals with private insurance, including those enrolled in Medicare Advantage, had the largest nationwide COPD-attributable medical costs at $11.42 billion, followed by individuals with Medicare at $10.83 billion and individuals with Medicaid at $3.03 billion.

In 2029, $60.5 billion is the projected amount for COPD-attributable medical costs using a 5.1% annual National Health Expenditure per capita growth rate, according to researchers.

Additionally, $3,083 per-patient is the projected 2029 national average cost.

“We feel that it is important for national and local policymakers, and providers, to have an up-to-date understanding of the burden COPD places on our economies so that informed decisions can be made,” Pollack told Healio. “Moreover, we’ve observed in our activities that there is an increasing focus on ‘localized’ evidence, yet again state-level estimates are lacking greatly. We hope that this updated view of the burden of COPD helps to inform these stakeholders to ensure that COPD patients and their treatment options are prioritized appropriately.”

When asked how these study findings impact everyday clinicians, Pollack said they provide a recent and future picture of the economic burden of COPD.

“We hope that these new estimates will provide updated information for clinicians as they have conversations within their communities and with peers regarding the burdens of COPD, the persistent unmet needs and the local and national investments that may be required to improve the delivery or quality of care,” Pollack told Healio. “Health care costs are an ongoing challenge for payers, patients and health systems to manage.”

“These findings can also act as a common reference extending the foundation created by Ford in 2015 so that updated COPD data can guide discussions and policy development among providers and policymakers,” Pollack added.

Looking ahead, Pollack hopes future studies outline economic estimates for other chronic conditions and generate more subnational or state-level estimates.

“We observed some noticeable variation in costs across states. Therefore, as future studies assess costs, we hope that additional sub-national estimates will be generated to benefit state and local stakeholders,” Pollack said.

Additional research on COPD-attributable medical costs could determine how cost estimates vary within racial/ethnic groups, Pollack said.

“Future studies that can project cost burdens across subgroups of patients can only help benefit national and local conversations about COPD and the unmet needs,” Pollack told Healio.

For insights on disparities between patients with vs. without COPD and across racial groups, Pollack recommends reading a study he helped on that was published in the International Journal of Chronic Obstructive Pulmonary Disease in May 2024.

References:

• Ford ES, et al. CHEST. 2015;doi:10.1378/chest.14-0972.
• Johnson KM, et al. CHEST. 2024;doi:10.1016/j.chest.2024.01.003.
• Roberts MH, et al. Int J Chron Obstruct Pulmon Dis. 2024;doi:10.2147/COPD.S446696.