Assessment and prediction of costs and adverse health outcomes in COPD

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DESCRIPTION (provided by the applicant): Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the United States and adds substantial economic burden to a health care system that is already under significant strain. To efficiently allocate our limited resources to maximize the overall health of our population, we must have a strong understanding of the total cost burden of this disease, including not only direct costs but also indirect costs such as lost work productivity. Moreover, having well-tested models which predict costs and adverse health outcomes is important in targeting disease management programs and, within a research context, when investigators are trying to understand the impact of a new exposure or intervention. Furthermore, risk adjustment for likely costs is critical in capitated payment mechanisms to discourage providers and insurers from avoiding high-cost patients and in risk-adjusting cost-efficiency evaluations of physicians. Poor risk adjustment methods may leave sicker patients with a dearth of physician and insurance-coverage options. The proposed study would add additional analyses and data collection to a parent study which has collected baseline survey and diagnostic testing information on a cohort of 1202 COPD subjects and 302 controls within Kaiser Permanente, a large integrated health system. The proposed study will first provide an assessment of both the direct and indirect costs for these subjects subsequent to their baseline assessment. We will utilize Kaiser's Cost Management Information System to determine direct costs. Indirect costs will be assessed with follow-up telephone surveys, using techniques similar to those employed by the applicant's research mentors in their examination of the indirect costs of asthma. Our second aim will then be to develop prediction-models for both costs and, as a secondary outcome, adverse health outcomes. These models will utilize both traditional measures used within risk-adjustment, such as sociodemographics and comorbidity data, and then test the additional predictive value of a multifaceted approach to measuring COPD severity. RELEVANCE: COPD is a leading cause of death and disability in the United States and adds substantial economic burden to a health care system which is already under considerable strain. Understanding the factors that drive costs in COPD, both costs borne by the institutions and by individuals, is critical to our ability to utilize our resources where they are needed most. Moreover, developing a transparent process to allow health care payers, such as the government, to predict which patients are likely to be the most costly will allow us to adjust payments to health insurers to discourage them from avoiding the sickest patients.