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The distribution of costs of care in mechanically ventilated patients with chronic obstructive pulmonary disease

Ely, Wesley E. MD, MPH, FCCP; Baker, Albert M. MD, FCCP; Evans, Gregory W. MA; Haponik, Edward F. MD, FCCP

Clinical Investigations
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Objectives: To delineate the costs of care of patients with Chronic Obstructive Pulmonary Disease (COPD) and respiratory failure and to compare them with those of other mechanically ventilated patients.

Design: Apost hocanalysis of a prospective investigation.

Setting: Medical and coronary intensive care units (ICUs) of an 804-bed, university-based hospital.

Patients: A total of 300 mechanically ventilated patients, 44 with COPD and 256 others, were included.

Measurements and Main Results: Despite similar lengths of ICU stay (9 days) and mechanical ventilation (5.5 days COPD vs. 5 days other,p= .11), ICU respiratory care costs for patients with COPD were $2,422 ($1,157-$6,110) [median U.S. dollars (interquartile range)] vs. $1,580 ($738-$3,322) for the others (p= .01). Ventilator costs for COPD patients were $1,795 ($943-$5,782) vs. $1,574 ($613-$3,112) (p= .12). Total hospitalization respiratory care costs for COPD patients were higher, $4,064 ($2,422-$9,572) vs. $2,342 ($1,186-$4,591), (p= .0001), and 74.4% of the median difference in cost between COPD patients and others was accounted for by spontaneous nebulizers (p= .001), metered dose inhalers (p= .01), and pulse oximetry (p= .02). By using multiple linear regression analyses, we found that COPD remained associated with higher respiratory costs (p< .05). Respiratory Care was the third largest category of hospital costs after beds (27%) and pharmacy expenses (25%), and it comprised ∼14% of total cost. Total hospital costs were large for both groups, but did not differ between COPD and the others [$24,217 ($16,211-$58,834) vs. $27,672 ($15,692-$53,766), respectively (p= .96)]. Linear regression analyses showed that only Acute Lung Injury score was significantly related to total ICU and hospital costs of care (p< .05).

Conclusions: Costs of ICU and non-ICU respiratory care for patients with COPD are higher than costs of care for other mechanically ventilated patients. Although the increased cost of bronchodilators and oximetry in these patients may serve as target areas for reductions in respiratory care costs, it may also be true that these modalities of therapy and management are necessary and need to be used with even greater intensity to achieve better outcomes. The predominant contributions of bed and pharmacy costs in all of our patients with respiratory failure support research efforts addressing these aspects of care.

From the Department of Internal Medicine, Section on Pulmonary and Critical Care Medicine (Drs. Ely and Haponik) and the Department of Public Health Sciences (Mr. Evans), Wake Forest University School of Medicine, Winston-Salem, NC, and Lynchburg Pulmonary Associates, Lynchburg, VA (Dr. Baker).

Address requests for reprints to: E. Wesley Ely, M.D., MPH, FCCP, Section on Allergy/Pulmonary/Critical Care Medicine, Vanderbilt Lung Transplant Program, Vanderbilt University School of Medicine, 913 Oxford House, Nashville, TN 37232-4760. E-mail: wes.ely@mcmail.vanderbilt.edu

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