Costs of the Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in a University Hospital

Objective: Chronic obstructive pulmonary disease (COPD), although a preventable and treatable disease continues to be a major health problem. Acute exacerbations of COPD is a major cause of hospitalization of patients and it constitutes a significant portion of COPD-related health care costs. In this study, we aimed to determine the cost of patients hospitalized with acute exacerbations of COPD in a university hospital. Methods: Data of the patients that were hospitalized due to COPD exacerbation between 1 September 2013-1 September 2014 in Hospital of Gazi University Medical Faculty were retrospectively analyzed. Cost data were gathered from data processing department. Costs were identified for drugs, laboratory tests, bed costs and other materials. Results: A total of 790 patients were hospitalized during twelve months. Among these patients 181 (23.0%) patients had COPD and 99 (12.5%) were hospitalized due to acute exacerbation of COPD. Of these 99 patients 77 (77.8%) were male and 22 (22.2%) were female. Forty-nine (49.5%) patients were hospitalized from the emergency department, 50 (50.5%) patients were from the outpatient clinic. The median age was 70 (64-77) years old and median length of hospital stay was 8 (6-13) days. Ninety-one (91.9%) of them were discharged from the service. Eight (8.1%) patients were transfered to the intensive care unit (ICU) due to respiratory failure, and 7 of these patients (7.4%) hospitalized back to the service after treatment at ICU, 2 (2.1%) patients died. The median cost per patient was 1.064 (726-1.866) Turkish Lira (TL). Drug costs accounted the largest portion (36.0%) of the median cost, followed by bed cost (26.0%). Two (2.1%) of patients died in hospital. Although the number of patients without antibiotic usage is less (17.2% vs 82.8%); the median cost per patient in the antibiotic using group was higher than that were without antibiotic using (median 643 vs 1.162 TL p=0.001). Presence of a comorbidity, hypoxemia, noninvasive mechanical ventilation (NIMV) requirement were existing factors that didn't increase the cost of patients (p>0.05). Only the use of antibiotics was detected as independent factors that increase the total cost (95% CI 0.487 to 12.984, p=0.030). Conclusion: Acute exacerbation of COPD continues to be an important cause of mortality and economic burden in the hospitalized COPD patients in pulmonary clinics.