CME: The Increasing Costs of COPD

CME: The Increasing Costs of COPD
Author Information (click to view)

Earl S. Ford, MD, MPH

Medical Epidemiologist
Centers for Disease Control and Prevention

Earl S. Ford, MD, MPH, has indicated to Physician’s Weekly that he has no financial interests to disclose.

Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

  1. Explain the methods and key results of a study in which researchers estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020;
  2. Cite several approaches that can help lower costs resulting from care for patients diagnosed with COPD.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at

Credit Available(click to view)


CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.


AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Christopher Cole – Senior Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Earl S. Ford, MD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.


Earl S. Ford, MD, MPH (click to view)

Earl S. Ford, MD, MPH

Medical Epidemiologist
Centers for Disease Control and Prevention

Earl S. Ford, MD, MPH, has indicated to Physician’s Weekly that he has no financial interests to disclose.

Research from the CDC indicates that COPD-attributable annual medical costs by payer and absenteeism were substantial in 2010. It is estimated that these costs will increase substantially by 2020.

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 adding an estimated $3.9 billion in absenteeism costs from 16.4 million days of work lost because of COPD, the total estimated burden increased to $36 billion. Based on the assumption that the prevalence of COPD remains unchanged, the study team estimated that total COPD-related costs would reach $49 billion in 2020.


Wide Variation by State

Dr. Ford and colleagues found a wide range in state-by-state data regarding COPD-attributable costs. Absenteeism costs were lowest in Wyoming ($5.7 million) and highest in California ($434.0 million). Medical costs ranged from $42.5 million in Alaska to $2.5 billion in Florida. “The wide variation observed in our analysis mostly reflects the population of the states,” Dr. Ford explains. “For example, Florida has a relatively large population that is older, on average, whereas Alaska has a much smaller population. Alaska has a lower prevalence of treated COPD (2.4%) than Florida (3.6%). There are 16,400 people being treated for COPD in Alaska, compared with 743,000 people in Florida.” He adds that regional variations in treating COPD could contribute to the cost differences that were seen from state to state. When Dr. Ford’s team broke down costs by payer, they found that about 18% of COPD-attributable costs were paid for by private insurance, 25% by Medicaid, and 51% by Medicare. The remaining costs were paid by uninsured patients or by individuals using other payment options. “The large portion of costs paid for by Medicare likely reflects the fact that people with COPD tend to be older,” adds Dr. Ford.

How to Lower Costs?

Researchers have estimated that 75% to 80% of COPD is attributable to smoking. “The obvious way to lower costs in general for COPD is to help prevent non-smokers from ever smoking,” says Dr. Ford. “This would prevent them from developing COPD in all likelihood. Another important strategy is to help smokers quit by enrolling them into effective smoking cessation programs.” Dr. Ford recommends the following approaches to further help lower costs resulting from care for patients who have already been diagnosed with COPD:

• Encourage patients to receive appropriate vaccinations.

• Ensure patients receive and adhere to appropriate medications. Research has shown that patients who adhere to their COPD medications are less likely to experience exacerbations and may reduce future hospitalizations, which are a significant driver of costs relating to COPD.

• Consider pulmonary rehabilitation programs. Studies show that proper pulmonary rehabilitation programs can help lower exacerbations and other COPD-related complications.

• Monitor cardiovascular disease risk factors. Patients with COPD are at increased risk for developing heart disease.

• Encourage and reinforce smoking cessation efforts. About 40% of COPD patients smoke. Any effort to reduce these rates will likely reduce costs relating to COPD care.

“With good medical management and a focus on smoking prevention or cessation, healthcare providers can help lower COPD-attributable costs,” says Dr. Ford. ”These efforts are critical to helping avoid reaching our total costs projections by the time we reach 2020.

Readings & Resources (click to view)

Ford E, Murphy L, 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. 2015;147:31-45. Available at

Lin J, Li Y, Tian H, et al. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia. Clinicoecon Outcomes Res. 2014;6:349-356.

Blanchette C, Gross J, Altman P. Rising costs of COPD and the potential for maintenance therapy to slow the trend. Am Health Drug Benefits. 2014;7:98-106.

Blasi F, Cesana G, Conti S, et al. The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease: a cohort of hospitalized patients. PLoS One. 2014;9:e101228.

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