Managed Care Outlook

COPD costs to approach $50B per year in 2020


Despite all the smoking-cessation efforts and the countless warnings by all the surgeons general, medical costs for chronic obstructive pulmonary disease (COPD) are expected to skyrocket by 2020, according to a study by the Centers for Disease Control and Prevention that was published in the journal Chest.

Direct and indirect costs will rise from about $32 billion a year in 2010 to about $49 billion annually by 2020. “Because approximately 75% of COPD is caused by smoking, the principal route to primary prevention is the prevention of smoking initiation and smoking cessation among those who smoke,” says the study.

Projection of excess national medical treatment costs because of COPD* (billions)

*Adjusted for demographics and 11 conditions, including hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy.

Source: Ford ES, Murphy LB, Khavjou O, et al. Total and state-specific medical and absenteeism costs of chronic obstructive pulmonary disease among adults aged ≥18 years in the United States for 2010 and projections through 2020. Chest, July 24, 2014 [Epub ahead of print].

The study breaks down present costs state by state, which should be useful to public policymakers because it “provides state public health practitioners with estimates of the economic burden of COPD within their borders and illustrates the potential medical and absenteeism costs savings to states through implementing state-level programs that are designed to prevent the onset of COPD (e.g., tobacco prevention and cessation).”

Medicare pays the lion’s share of COPD costs, about 51%. Medicaid pays about 25% and private insurance covers 18%. Researchers note that “COPD is a recognized risk factor for multiple costly chronic conditions such as cardiovascular disease, pneumonia, and depression, and, therefore, an estimate of the attributable cost of COPD should include its sequelae.”

Hospitalizations take up a large portion of the COPD bill, and the authors suggest strategies for addressing this. Says the report, “A review of interventions to reduce the rate of hospitalizations among long-term-care facility residents noted that the most promising interventions included hiring more nurse practitioners and physician assistants, increasing the numbers of registered nurses who work in long-term care facilities, increased attention to the transfer from the hospital back to the long-term care facility or home, favoring home health care over hospital care, and policy interventions related to financial incentives.”