HLT-490V-R5: Increase cost of Chronic Obstructive Pulmonary Disease

INCREASED COST OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
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Abstract
This research proposal explores fourteen published articles that report on interventions to be taken in order to reduce Chronic Obstructive Pulmonary Disease (COPD) burden. The articles present various evident-based interventions that when utilized can lead to a significant decrease in financial challenges associated with COPD. Exacerbations resulting from the disease are known to be the major cause of increased mortality and morbidity, and also increase the risk of advanced COPD progression. In the advanced cases of the disease, patients are likely to suffer more aggravated symptoms; this then leads to increased costs in the management of the debilitating disease. The paper will also look into an important theory – the self-determination theory – which is critical in the implementation and integration of the learned interventions and knowledge. Afterwards, proposed solutions to the problem of increased costs in COPD management will be discussed. Alongside these solutions, a well-defined implementation plan will be provided together with a detailed dissemination plan. The dissemination plan helps the evidence-based information related to lowering COPD costs reach intended audience. Lastly, a conclusive summary of any gaps in the research materials will be addressed and areas of correction in the future provided.
Keywords: Chronic Obstructive Pulmonary Disease, exacerbations, self-determination theory.
Increased Cost of Chronic Obstructive Pulmonary Disease: Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a general term for two debilitating conditions of the airway, emphysema and chronic bronchitis. Normally, the condition is associated with increased air flow resistance into the lungs. When there is any form of resistance to the normal flow of air into the lungs, breathing problems occur. Chronic Obstructive Pulmonary Disease is considered an economic burden, especially in the modern world due to the huge amounts of money required in the management of the disease. Like in all chronic diseases, the economic burden brought about by COPD may either be direct or indirect. Direct costs refer to costs that are incurred in the healthcare setting while managing the condition. As such, costs related to diagnosis, prevention, treatment, and overall COPD management are considered direct costs. On the other hand, indirect costs refer to both mortality and morbidity caused by COPD. In this case, costs related to inability to work are considered indirect.
In the United States, for example, the total expenditure utilized in COPD management totaled $49.9 billion in 2010. Of the $49.9 billion, $20 billion were indirect costs while the remaining $29.9 billion went into direct expenditures in health care settings. The costs are indeed expected to rise due to increasing number of new COPD cases that are being diagnosed annually. It is currently projected that each COPD patient takes approximately $4,000 every year. A study was conducted on 78 patients at various stages of COPD by McDonough et al (2011) to analyze how Small-Airway Obstruction relates to the risk of developing Chronic Obstructive Pulmonary Disease. The study showed that narrow airways led to increased air flow resistance in COPD patients. This study serves as the first body of evidence that exacerbations brought about by airway narrowing leads to increased COPD risk.
Problem
Chronic Obstructive Pulmonary Disease exacerbations underline the main theme of this paper. Exacerbations are referred to as acute phases of COPD usually characterized by unstable and worsening conditions in the respiration. Such cases of exacerbations require urgent solutions in order to stabilize the patient; such solutions include medications. Sometimes, a change of medication is required, especially if the patient did not respond well to the medication. A number of published articles have adequately mentioned COPD exacerbations as the mainstay of extended hospitalizations and subsequent increase in costs associated with the condition. A good number of studies show that it is possible to control COPD exacerbations and manage the condition in the long-term. The long-term management of these exacerbations requires different interventions including medical and patient care. However, one single study by Brunetti et al (2015) indicate that despite the integration of both medical and patient care interventions, exacerbations are not alleviated. The analysis of these articles presents a big gap, and indeed problems, in finding a conclusive answer to the ultimate management of COPD exacerbations.
Another problem that arises from the analysis of the articles is the lack of standardized definition and classification of exacerbations. A general explanation of the term is available, but not the definitive classification. As a result, there is no universally accepted definition, biomarker, or test of exacerbation in COPD.
Purpose
In light of the issues addressed above, it is important to focus on every evidence-based research article in order to understand the gap that exists in enhancing COPD management interventions. At the current rates of COPD diagnosis, it is worrying to note the potential expenditure costs that are likely to be incurred as a result of hospitalization rates. Strong recommendations on sustainable interventions and knowledge are required in order to improve patient outcomes from the COPD menace. The paper, therefore, objectively addresses these challenges and makes recommendations as well as implementation and dissemination plans with the sole purpose of reducing costs in COPD.
Questions
In analyzing the available body of evidence, there are critical questions that need to be considered so as to find a conclusive solution to the challenge of increase in cost in the management of COPD. For example, there are interventions that are medication-based, and that have been found to be effective in the reduction of exacerbations associated with the condition. However, what medication interventions are more appropriate than others in reducing exacerbations and hospitalization rates? What medical interventions will not work at all? Are medical interventions effective on their own? Is it more advantageous to introduce patient care to already existing medical interventions? What gaps in research still need to be addressed? These questions act as a guide in addressing every aspect that the paper mentions.
Literature Review
There is a sufficient evidence-based research that points to the need for developing viable solutions intended to reduce exacerbations. This is because exacerbation is considered the most important determinant of COPD hospitalization rates, mortality, and morbidity rates. McDonough et al (2011), in their study on Small-Airway Obstruction, found that narrow airways increased the airway resistance in patients with COPD. The researchers based the research on 78 patients at varying stages of the condition, and relied on results from a multidetector computer tomography scan to identify ways in which obstruction affected the risk of Chronic Obstructive Pulmonary Disease development. The results of these researchers are consistent and in alignment with the objective of developing strong interventions that are geared at reducing destructive effects of COPD.
Further, researchers have identified exacerbation as a major determinant of patients’ quality of life and healthcare costs. Miravitlles et al (2013) carried out an investigation to identify the relationship between exacerbations in COPD and healthcare costs. Their study focused on 260 patients on different antibiotic therapies in the treatment and management of COPD. The sample average age was 68.3 years. Results from this study revealed that patients on antibiotic regimes had lower hospitalization rates compared to those who did not use any antibiotic. According to this research, failure of antibiotic treatment results into increased exacerbations that in turn lead into higher costs of management of the condition. The study by the researchers is relevant to this project because it underscores the relationship between patients’ health outcomes and cost analysis of exacerbations.
There are major concerns that the burdens of COPD will grossly affect the healthcare sector, even in the presence of preventive measures that improve health outcomes. For example, Mapel et al (2005) carried out a study to determine the effects of different intervention strategies on costs associated with COPD. The investigation relied on a population-based cohort study, and linked different interventions – medical-based - with direct healthcare costs. The study also used a predictive model to show how these healthcare costs varied in different sets of patients. Results indicated that as the exacerbations of COPD increased, so did the healthcare costs and resource utilization. Airway obstruction was identified as the single most critical factor that increased COPD severity. From the results, there is a need to focus on reliable treatment methods that can prevent severity in airway obstruction and bring the costs associated with hospitalization down. The research by Mapel et al is quite relevant in this research paper since it presents an informative guide of what is needed before COPD becomes a global emergency. According to the researchers, COPD will be the third leading cause of mortality and morbidity in the United States by the year 2020.
Rutten-van Mölken et al (2007) are another group of researchers who have studied the effects of medical interventions on reducing cost of COPD management. They utilized roflumilast; a selective and long-acting anti-inflammatory agent used in severe Chronic Obstructive Pulmonary Disease and a placebo, and compared the effectiveness of each. They carried out a randomized trial on 1514 patients above the age of 40.761 patients received roflumilast while 753 patients were put on a placebo. Throughout the study, all patients continued receiving inhaled corticosteroid therapy or other active treatments. Results indicated that interventions to reduce exacerbations prevented mortality related to COPD. However, it is also important to note that there were no significant differences between the two groups of patients; which also confirms the need for more in-depth research. Despite that, the study by these researchers is relevant because it is related to development of more viable interventions to reduce COPD exacerbations. Improving patients’ health outcomes by preventing exacerbations should be the main goal.
On combination of medical-based interventions and usual patient care, Friedman, Menjoge, Anton, & Kesten (2004) reviewed two randomized control trials. The first trial involved utilization of patient care without administration of tiotropium – a long-acting anticholinergic bronchodilator effectively used in COPD management. The second trial involved administering tiotropium and usual patient care. Results from their review showed that patients on tiotropium therapy had a 20% lower risk of developing COPD exacerbations. On the other hand, the patients on the ‘usual care only group’ had an increased risk of developing exacerbations. Since this review achieved considerable success, it aligns with the major objectives of this paper – looking for more approaches of managing COPD beyond normal patient care.
Briggs et al (2006) continue on where past researchers stop on medical-based interventions. In their study, the researchers evaluated the effects of Fluticasone Propionate (FP) on minimizing mortality and improving the quality of life in patients suffering from Chronic Obstructive Pulmonary Disease. They relied on previous data from the Inhaled Steroids in Obstructive Lung Disease in Europe (ISOLDE) clinical trial to measure direct and indirect costs as a result of exacerbations. In their study, patients were grouped into two: those receiving Fluticasone Propionate alone and those receiving a placebo. Basing their results on the quality of life, the researchers found that FP was indeed cost effective as it reduced mortality and improved the quality of life in patients receiving the treatment. As for those in the placebo group, neither improvement in the quality of life nor reduction in mortality was observed.
In yet another review, Srivastava, Thakur, Sharma, & Punekar (2015) investigated quality of life and economic burden affected patients with symptomatic chronic obstructive pulmonary disease. The researchers used 32 studies where health outcomes were grossly affected; additionally, the symptomatic condition imposed higher economic burdens on patients and their families as well as health care facilities. Results of the review showed that severity of the symptoms was directly proportional to the increased healthcare costs. However, the severity of symptoms was aggravated due to the presence of other comorbidities. Comorbidities are other chronic conditions that are likely to increase the symptoms of the underlying obstructive condition. They include heart failure, hypertension diabetes among other diseases. It is believed that systemic inflammation is the major cause of all these diseases, which in turn lead to aggravated symptoms in COPD. Efforts should therefore be made to reduce COPD severity in order to improve the quality of life in patients.
The economic burden of COPD is gradually increasing in the United States. According to Guarascio, Ray, Finch, & Self (2013), it is estimated that the country spends $50 billion in healthcare costs related to COPD; $20 billion are indirect costs that are incurred due to mortality and morbidity cases, while $30 billion are direct costs incurred in hospitalizations, physician visits, and other direct healthcare costs. The researchers agree that stabilizing COPD and reducing its exacerbations should be the main goal in reducing costs. They posit that there are a number of medication therapies that can be utilized, and that it is the opportune time to implement such interventions. In one of their study, the researchers conclude that it is important to consider mediators that increase the risk of COPD. Good examples of mediators include tobacco use and subsequent dependence and increase in life expectancy – which exposes individuals to greater risk factors of COPD.
A further study on the cost implications and resource use in COPD and chronic bronchitis patients was carried out by Pasquale et al (2012). The study confirmed the relevance of relying on new interventions because increased health costs are mainly brought about by exacerbations in these groups of patients. The researchers relied on data from a national health plan in their evaluation criteria. The study had a total of 8554 patients. Of these patients, 49.8% had severe exacerbations. Despite utilization of medication and usual patient care interventions in this study, the exacerbations still persisted. This is unlike the studies and reviews on the use of roflumilast, tiotropium, and fluticasone propionate (FP). It seems, then, that different medications respond differently to exacerbations due to COPD and chronic bronchitis.
A prospective study by Brunetti et al (2015) confirms the weight of the exacerbations matter reporte...