Misdiagnoses and mismanagement of COPD impacts health costs

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality in the U.S. and, as a result, rising healthcare costs.

Physicians might think that undiagnosed COPD does not cost the healthcare system anything, but studies show that among COPD patients, utilization and costs for non-respiratory ailments are at least as great as those attributable to respiratory illness. Undiagnosed COPD has a substantial impact on healthcare costs and utilization, particularly for hospitalizations.

National data from the Centers for Medicare & Medicaid Services show COPD is extremely costly, with the total costs from hospital admission and absenteeism is estimated at $36 billion annually, according to the latest data. Furthermore, the Centers for Disease Control and Prevention (CDC) states the national medical costs attributable to COPD and its consequences were estimated at $32 billion and total absenteeism costs were about $4 billion. Of the medical costs, about less than one quarter was paid for by private insurance, slightly more than half by Medicare and one-quarter by Medicaid.

The CDC data suggest that national medical costs for COPD are projected to increase to $49 billion in 2020. Rising costs are leading payers to work with healthcare providers and health systems to improve care coordination for patients with chronic diseases, including COPD.

However, the actual cost could be even higher than these estimates as people with COPD often have other comorbidities and hospital treatment costs that are typically difficult to attribute specifically to a particular disease. A substantial proportion of COPD patients remain undiagnosed and have a higher risk of mortality than those without airflow obstruction.

“I think it is difficult to completely quantify the economic impact of COPD misdiagnosis, but data suggest that undiagnosed COPD has a significant impact on healthcare costs. We know that appropriate therapy can help reduce the frequency of exacerbations and that exacerbations account for 50% to 75% of direct COPD healthcare costs,” Meilan Han, MD, associate professor in the University of Michigan’s Division of Pulmonary and Critical Care, told Medical Economics.

Next: Study results

One study of 6,864 COPD patients enrolled in a managed care plan included all utilization and direct medical costs compiled monthly and compared based on the time before and after the initial diagnosis. The results show the total costs for COPD patients were higher by an average of $1,182 per patient in the two years before their initial COPD diagnosis and $2,489 in the 12 months just before their initial diagnosis as compared to matched controls, with most of the higher cost attributable to hospitalizations.

Inpatient costs did not increase after the diagnosis was made, but approximately one-third of admissions after the diagnosis were attributed to respiratory disease. Outpatient and pharmacy costs did not differ substantially between cases and controls until just a few months before the initial diagnosis, but remained 50% to 100% higher for patients than for controls in the two years after diagnosis.

Misdiagnoses are expensive in not only human costs, but also in costs of inappropriate and unnecessary medications and resulting healthcare utilization.

“When long-term smokers are diagnosed with heart disease to explain their dyspnea on exertion, they are prescribed multiple drugs. It is likely that none of those drugs will address the dyspnea that may be from COPD. People who have 20 and more pack-year histories who have a diagnosis of heart disease deserve an evaluation of lung function since tobacco smoke adversely affects both heart and lungs,” Barbara Yawn, MD, adjunct professor of family and community health at the University of Minnesota, told Medical Economics.

When patients are misdiagnosed and don't respond, they usually receive multiple additional medications, testing and evaluations as well as referrals to specialists who may continue to work with that misdiagnosis, she added.    

Over-diagnosis can also be expensive. “Calling shortness of breath and declining activity tolerance COPD because a person smokes can miss lung cancer, heart disease and asthma-all of which are not most responsive to the long-acting bronchodilators of COPD,” said Yawn. “The costs include unnecessary medications, continued symptoms that can affect ability to function and often progression to more severe disease that could have been prevented or at least modulated.”