8 research outputs found
Determinants of healthcare utilization and costs in COPD patients: first longitudinal results from the German COPD cohort COSYCONET
Background: In light of overall increasing healthcare expenditures, it is mandatory to study determinants of future costs in chronic diseases. This study reports the first longitudinal results on healthcare utilization and associated costs from the German chronic obstructive pulmonary disease (COPD) cohort COSYCONET. Material and methods: Based on self-reported data of 1904 patients with COPD who attended the baseline and 18-month follow-up visits, direct costs were calculated for the 12 months preceding both examinations. Direct costs at follow-up were regressed on baseline disease severity and other co-variables to identify determinants of future costs. Change score models were developed to identify predictors of cost increases over 18 months. As possible predictors, models included GOLD grade, age, sex, education, smoking status, body mass index, comorbidity, years since COPD diagnosis, presence of symptoms, and exacerbation history. Results: Inflation-adjusted mean annual direct costs increased by 5% (n.s., (sic)6,739 to (sic)7,091) between the two visits. Annual future costs were significantly higher in baseline GOLD grades 2, 3, and 4 (factors 1.24, 95%-confidence interval [1.07-1.43], 1.27 [1.09-1.48], 1.57 [1.27-1.93]). A history of moderate or severe exacerbations within 12 months, a comorbidity count > 3, and the presence of dyspnea and underweight were significant predictors of cost increase (estimates ranging between + (sic)887 and + (sic)3,679, all p<0.05). Conclusions: Higher GOLD grade, comorbidity burden, dyspnea and moderate or severe exacerbations were determinants of elevated future costs and cost increases in COPD. In addition we identified underweight as independent risk factor for an increase in direct healthcare costs over time
The association of cognitive functioning as measured by the DemTect with functional and clinical characteristics of COPD : results from the COSYCONET cohort
Alterations of cognitive functions have been described in COPD. Our study aimed to disentangle the relationship between the degree of cognitive function and COPD characteristics including quality of life (QoL).
Data from 1969 COPD patients of the COSYCONET cohort (GOLD grades 1–4; 1216 male/ 753 female; mean (SD) age 64.9 ± 8.4 years) were analysed using regression and path analysis. The DemTect screening tool was used to measure cognitive function, and the St. George‘s respiratory questionnaire (SGRQ) to assess disease-specific QoL.
DemTect scores were  =60 years of age. For statistical reasons, we used the average of both algorithms independent of age in all subsequent analyses. The DemTect scores were associated with oxygen content, 6-min-walking distance (6-MWD), C-reactive protein (CRP), modified Medical Research Council dyspnoea scale (mMRC) and the SGRQ impact score. Conversely, the SGRQ impact score was independently associated with 6-MWD, FVC, mMRC and DemTect. These results were combined into a path analysis model to account for direct and indirect effects. The DemTect score had a small, but independent impact on QoL, irrespective of the inclusion of COPD-specific influencing factors or a diagnosis of cognitive impairment.
We conclude that in patients with stable COPD lower oxygen content of blood as a measure of peripheral oxygen supply, lower exercise capacity in terms of 6-MWD, and higher CRP levels were associated with reduced cognitive capacity. Furthermore, a reduction in cognitive capacity was associated with reduced disease-specific quality of life. As a potential clinical implication of this work, we suggest to screen especially patients with low oxygen content and low 6-MWD for cognitive impairment
Gender-specific differences in COPD symptoms and their impact for the diagnosis of cardiac comorbidities
Background In chronic obstructive pulmonary disease (COPD), gender-specifc diferences in the prevalence of symptoms
and comorbidity are known.
Research question We studied whether the relationship between these characteristics depended on gender and carried diag nostic information regarding cardiac comorbidities.
Study design and methods The analysis was based on 2046 patients (GOLD grades 1–4, 795 women; 38.8%) from the
COSYCONET COPD cohort. Assessments comprised the determination of clinical history, comorbidities, lung function,
COPD Assessment Test (CAT) and modifed Medical Research Council dyspnea scale (mMRC). Using multivariate regres sion analyses, gender-specifc diferences in the relationship between symptoms, single CAT items, comorbidities and
functional alterations were determined. To reveal the relationship to cardiac disease (myocardial infarction, or heart failure,
or coronary artery disease) logistic regression analysis was performed separately in men and women.
Results Most functional parameters and comorbidities, as well as CAT items 1 (cough), 2 (phlegm) and 5 (activities), dif fered signifcantly (p<0.05) between men and women. Beyond this, the relationship between functional parameters and
comorbidities versus symptoms showed gender-specifc diferences, especially for single CAT items. In men, item 8 (energy),
mMRC, smoking status, BMI, age and spirometric lung function was related to cardiac disease, while in women primarily
age was predictive.
Interpretation Gender-specifc diferences in COPD not only comprised diferences in symptoms, comorbidities and func tional alterations, but also diferences in their mutual relationships. This was refected in diferent determinants linked to
cardiac disease, thereby indicating that simple diagnostic information might be used diferently in men and women.
Clinical trial registration The cohort study is registered on ClinicalTrials.gov with identifer NCT01245933 and on Ger manCTR.de with identifer DRKS00000284, date of registration November 23, 2010. Further information can be obtained
on the website http://www.asconet.net
Reduced decline of lung diffusing capacity in COPD patients with diabetes and metformin treatment
We studied whether in patients with COPD the use of metformin for diabetes treatment was linked to
a pattern of lung function decline consistent with the hypothesis of anti-aging efects of metformin.
Patients of GOLD grades 1–4 of the COSYCONET cohort with follow-up data of up to 4.5 y were
included. The annual decline in lung function (FEV1, FVC) and CO difusing capacity (KCO, TLCO)
in %predicted at baseline was evaluated for associations with age, sex, BMI, pack-years, smoking
status, baseline lung function, exacerbation risk, respiratory symptoms, cardiac disease, as well
as metformin-containing therapy compared to patients without diabetes and metformin. Among
2741 patients, 1541 (mean age 64.4 y, 601 female) fulflled the inclusion criteria. In the group with
metformin treatment vs. non-diabetes the mean annual decline in KCO and TLCO was signifcantly
lower (0.2 vs 2.3, 0.8 vs. 2.8%predicted, respectively; p < 0.05 each), but not the decline of FEV1 and
FVC. These results were confrmed using multiple regression and propensity score analyses. Our
fndings demonstrate an association between the annual decline of lung difusing capacity and the
intake of metformin in patients with COPD consistent with the hypothesis of anti-aging efects of
metformin as refected in a surrogate marker of emphysema
Direct and indirect costs of COPD progression and its comorbidities in a structured disease management program: results from the LQ-DMP study
Background: Evidence on the economic impact of chronic obstructive pulmonary disease (COPD) for third-party payers and society based on large real world datasets are still scarce. Therefore, the aim of this study was to estimate the economic impact of COPD severity and its comorbidities, stratified by GOLD grade, on direct and indirect costs for an unselected population enrolled in the structured German Disease Management Program (DMP) for COPD.Methods: All individuals enrolled in the DMP COPD were included in the analysis. Patients were only excluded if they were not insured or not enrolled in the DMP COPD the complete year before the last DMP documentation (at physician visit), had a missing forced expiratory volume in 1 s (FEV1) measurement or other missing values in covariates. The final dataset included 39,307 patients in GOLD grade 1 to 4. We used multiple generalized linear models to analyze the association of COPD severity with direct and indirect costs, while adjusting for sex, age, income, smoking status, body mass index, and comorbidities.Results: More severe COPD was significantly associated with higher healthcare utilization, work absence, and premature retirement. Adjusted annual costs for GOLD grade 1 to 4 amounted to (sic)3809 [(sic)3691-(sic)3935], (sic)4284 [(sic)4176-(sic)4394], (sic)5548 [(sic)5328-(sic)5774], and (sic)8309 [(sic)7583-9065] for direct costs, and (sic)11,784 [(sic)11,257-(sic)12,318], (sic)12, 985 [(sic)12,531-13,443], (sic)15,805 [(sic)15,034-(sic)16,584], and (sic)19,402 [(sic)17,853-(sic)21,017] for indirect costs. Comorbidities had significant additional effects on direct and indirect costs with factors ranging from 1.19 (arthritis) to 1.51 (myocardial infarction) in direct and from 1.16 (myocardial infarction) to 1.27 (cancer) in indirect costs.Conclusion: The findings indicate that more severe GOLD grades in an unselected COPD population enrolled in a structured DMP are associated with tremendous additional direct and indirect costs, with comorbidities significantly increase costs. In direct cost category hospitalization and in indirect cost category premature retirement were the main cost driver. From a societal perspective prevention and interventions focusing on disease control, and slowing down disease progression and strengthening the ability to work would be beneficial in order to realize cost savings in COPD
Impact of the COVID-19 pandemic on the behaviour and health status of patients with COPD: results from the German COPD cohort COSYCONET
Background:
Infection control measures for coronavirus disease 2019 (COVID-19) might have affected management and clinical state of patients with COPD. We analysed to which extent this common notion is fact-based.
Methods:
Patients of the COSYCONET cohort were contacted with three recurring surveys (COVID1, 2 and 3 at 0, 3 and 6 months, respectively). The questionnaires comprised behaviour, clinical and functional state, and medical treatment. The responses to the questionnaires were compared amongst themselves and with pre-COVID information from the last visit of COSYCONET.
Results:
Overall, 594 patients were contacted and 375 patients (58% males, forced expiratory volume in 1 s (FEV1) 61±22% predicted) provided valid data in COVID1 and COVID2. Five patients reported infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most patients – except for patients with higher education – reported compliance with recommended protective measures, whereby compliance to hygiene, contact and access to physicians slightly improved between COVID1 and COVID2. Also, patients obtained more information from physicians than from public media. In the majority of cases, the personal physician could not be substituted by remote consultation. Over time, symptoms slightly increased and self-assessed physical capacity decreased. Results of COVID3 were similar. Women and patients with more exacerbations and dyspnoea avoided medical consultations, whereas Global Initiative for Chronic Obstructive Lung Disease (GOLD) D patients were more amenable to tele-consultation.
Conclusion:
In well-characterised COPD patients, we observed on average slight deteriorations of clinical state during the period of COVID-19 restrictions, with high and partially increasing adherence to protective measures. The data suggest that in particular, women and GOLD D patients should be actively contacted by physicians to identify deteriorations