National and Local Direct Medical Cost Burden of COPD in the United States From 2016 to 2019 and Projections Through 2029

Background: Despite the significant burden posed by chronic obstructive pulmonary disease (COPD) to healthcare systems, there is a lack of up-to-date information quantifying the general COPD burden, costs, and long-term projections to various stakeholders in the United States.Research Question: What are the updated state-specific and nationwide estimates of the COPD disease burden and direct costs in 2019, along with projections of COPD-attributable medical costs through 2029?Study Design and Methods: A cross-sectional, retrospective study design using the 2016-2019 Medical Expenditure Panel Survey (MEPS), 2019 American Community Survey (ACS), and 2019 Behavioral Risk Factor Surveillance System (BRFSS) data was applied to generate COPDattributable expenditure estimates.Cost projections for the years 2020 to 2029 were based on 2017 National Population Projections reported by the Census Bureau and all costs were adjusted to 2019 US dollars.Results: In total, 4,135 people living with COPD were included, of which a higher proportion had other concurrent conditions such as cardiovascular-related conditions compared to people without COPD (N=86,021).Overall, in 2019, COPD-attributable medical costs after adjusting for demographics and 19 concurrent conditions (including COPD-related and non-COPD-related conditions) were estimated at $31.3 billion, with state-specific cost estimates reporting wide variation: from $44.8 million in Alaska to $3.1 billion in Florida.Nationwide COPD-attributable medical costs borne by payer type were as follows: private insurance, $11.4 billion; Medicare, $10.8 billion; Medicaid, $3.0 billion.Projections of national medical costs attributable to COPD are reported to increase to $60.5 billion in 2029.Interpretation: Understanding the current disease and economic burden of COPD in the US, along with the projected costs attributable to COPD in the next decade, will highlight unmet needs and gaps in care that help inform healthcare decision-makers in planning future actions to alleviate this disease burden. J o u r n a l P r e -p r o o fChronic obstructive pulmonary disease (COPD) is a progressive disease that causes persistent respiratory symptoms such as difficulty in breathing, chronic cough, and phlegm production. 1 Periodic exacerbations associated with COPD result in reduced life expectancy and increased morbidity, mortality, and cost. 2 Chronic lower respiratory diseases, mainly COPD, accounted for 4.5% of total deaths (more than 150,000 deaths) in 2020, making it the sixth-leading cause of death in the United States (US). 3 In 2018, before the COVID-19 pandemic, COPD was the fourth-leading cause of death in the US and the leading cause of morbidity, with almost 340,000 patients hospitalized for a diagnosis of COPD and almost 850,000 emergency department visits attributed to COPD. [4]] Based on data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), among US adults in all 50 states, DC, and 2 US territories, the age-adjusted prevalence of COPD was 6.2%. 7] According to this same research, the age-adjusted prevalence of COPD varied considerably by state, from <4.7% in Alaska, Colorado, Hawaii, Massachusetts, Minnesota, New Mexico, New York, and Utah to >8% in Alabama, Arkansas, Kentucky, and West Virginia.States with the highest age-adjusted COPD prevalence were clustered along the Ohio and lower Mississippi Rivers, 10 pointing to possible regional variation in COPD prevalence and disparities in healthcare delivery that require additional insight. 11010, the total unadjusted incremental medical cost for COPD in the US was estimated to be $72.7 billion; after adjustment for demographics and concurrent conditions other than asthma, pneumonia, cardiovascular, and mental health conditions, this amount was $32.1 billion. 12Ford et al used Medical Expenditure Panel Survey (MEPS) data to describe these costs in 2010 and extrapolate estimates over the next 10 years for an estimate of adjusted COPD-attributable costs of $49.0 billion in 2020. 12Anticipated direct costs, state-specific cost estimates, and projected burden of disease are important parameters that help to plan for future care, research, and policy.However, up-to-date information quantifying the burden of COPD in each state and attributable direct medical costs in the US is lacking.This study aimed to estimate the direct medical cost burden of COPD by each J o u r n a l P r e -p r o o f a Adjusted for demographic factors include age, age squared, education, family income, race/ethnicity, sex, sources of health insurance, and year.b Adjusted for select concurrent conditions not considered to be COPD-related include arthritis, back problems, cancer, diabetes, dyslipidemia, HIV/AIDS, hypertension, injuries, pregnancy, renal failure, and skin disorders.c Adjusted for COPD-related and non-COPD-related 19 concurrent conditions include asthma, arthritis, back problems, cancer, congestive heart failure, coronary heart disease, depression and other mental health and/or substance abuse problems, diabetes, dyslipidemia, HIV/AIDS, hypertension, injuries, other heart diseases, pneumonia, pregnancy, renal failure, skin disorders, and stroke.d Not projected, actual 2019 medical treatment cost values obtained from MEPS data e 10-year projected total for 2020-2029