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The Increasing Costs of COPD

The Increasing Costs of COPD

Chronic lower respiratory disease—the large majority of which is COPD—currently ranks as the third leading cause of mortality in the United States. Recent estimates of the costs associated with chronic lower respiratory disease have presented asthma and COPD together, which does not allow for a true understanding of the costs of COPD to the national healthcare system. Fur-ther complicating available data is the fact that patients with COPD often have a multitude of comorbidities. “Most COPD is attributable to smoking, which can also cause heart disease, cancer, and many other conditions,” explains Earl S. Ford, MD, MPH. “This makes it difficult to understand what costs are directly attributable to COPD and what costs are actually attributable to conditions that co-exist with COPD. Some of the previous studies looking at the costs of COPD have likely included ‘double counting’ from not factoring in costs that are actually attributable to these comorbidities.” A Thorough Analysis For a study published in Chest, Dr. Ford and colleagues estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020. The team used the 2006 to 2010 Medical Expenditure Panel Survey, 2004 National Nursing Home Survey, and 2010 CMS data to generate cost estimates and 2010 census data to project medical costs through 2020. “We felt that the most presentable costs were those that were estimated after accounting for 11 comorbidities, including heart disease, pneumonia, diabetes, asthma, and depression,” adds Dr. Ford. After accounting for these other comorbidities, the researchers estimated that the 2010 costs attributable to COPD and its sequelae were $32.1 billion (Figure). By...
Previous Respiratory Disease & Lung Cancer

Previous Respiratory Disease & Lung Cancer

Studies have suggested a relationship between previous respiratory diseases and a lung cancer diagnosis. Most of this research has been conducted in Asian populations and does not account for the high level of co-occurrence that has been observed among different respiratory diseases. To better understand the relationship between multiple previous respiratory diseases and lung cancer risk, Paolo Boffetta, MD, MPH, and colleagues pooled data from a consortium of seven case-control studies as part of the SYNERGY project, which provided detailed information on smoking habits in European and North American populations. New Findings Data on five previous respiratory diseases—chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma—were collected by self-report for the study, which was published in the American Journal of Respiratory and Critical Care Medicine. Analyses were stratified by gender and adjusted for study center, age, employment in an occupation with an excess risk of lung cancer, level of education, smoking status, cigarette pack-years, and time since quitting smoking. According to the results, patients with chronic bronchitis, emphysema, and pneumonia were at higher risk of lung cancer when compared with those who had no previous respiratory disease diagnoses. In men, chronic bronchitis and emphysema were associated with odds ratios (ORs) of 1.33 and 1.50, respectively, for lung cancer. Men who were diagnosed with pneumonia 2 or fewer years prior to lung cancer were also at greater risk of lung cancer (OR, 3.31), but this correlation leveled off when a pneumonia diagnosis was made after the 2-year threshold. Patients with co-occurring chronic bronchitis, emphysema, and pneumonia had a higher risk of lung cancer than those who had any of these conditions alone....
Life Expectancy in 2013

Life Expectancy in 2013

Life expectancy at birth represents the average number of years that a group of infants would live if the group was to experience throughout life the age-specific death rates present for their year of...
Getting Third Parties Out Of The Exam Room

Getting Third Parties Out Of The Exam Room

Any physician, especially primary care physicians, can tell you that they are frequently forced to make a decision based on a third party’s opinion. Most often, this will be an insurance company denying a prescribed medication or test; the discussion in the exam room evolves into a discussion of what is covered by the patient’s health plan—and what is not. The goal of providing the best medical care is often overruled by some of those decisions. Of course, the insurance company will tell you that they are not making medical decisions, and the patient can pay out of pocket if they would still like the medication or the diagnostic test. Most patients will chose to go with what their plan covers, either for financial reasons, or they feel they are paying an insurance premium, and their insurer should be paying for their medical care. All too often, I find myself playing the appeals game with the insurance companies in order to get appropriate care for my patients. For example, I recently saw a young asthmatic patient who was controlled on a certain inhaler for many years. They had tried others, but those had all failed to relieve the asthmatic symptoms. The insurance company decided that the patient would have to fail on a trial of one of the inhalers they had already failed on in the past before covering the current inhaler. Well, patients can end up in the ER or even die from an exacerbation of asthma. Clearly, this was not in the patient’s best interest. Why should third parties not be allowed in the exam room? *...
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