Healthcare utilization, medical costs and mortality associated with malnutrition in patients with chronic obstructive pulmonary disease

a matched cohort study

Jih Shuin Jerng, Chao Hsiun Tang, Rhoda Wen Yi Cheng, Michael Yao Hsien Wang, Kuan Yu Hung

Research output: Contribution to journalArticle

Abstract

Objective: Although disease-related malnutrition has prognostic implications for patients with chronic obstructive pulmonary disease (COPD), its health-economic impact and clinical burdens are uncertain. We conducted a population-level study to investigate these questions. Methods: We excerpted data relevant to malnutrition, prolonged mechanical ventilation and medications from claims by 1,197,098 patients which were consistent with COPD and registered by the Taiwan National Health Insurance Administration between 2009 and 2013. These patients were separated into cohorts with or without respiratory failure requiring long-term mechanical ventilation, and each cohort was divided to compare cases who developed malnutrition after their first diagnosis consistent with COPD, versus non-malnourished propensity-score matched controls. Results: The prevalence of malnutrition was 3.8% overall (10,259/287,000 non-ventilator-dependent; 1198/15,829 ventilator-dependent). Propensity-score matched non-ventilator-dependent patients who became malnourished (N = 10,242) had comparatively more hospitalizations, emergency room and outpatient visits, longer hospitalization (all p <.01), and higher mortality (HR = 2.26, 95% CI 2.18–2.34) than non-malnourished controls (N = 40,968). Malnourished ventilator-dependent patients (N = 1197) had higher rates of hospitalization, emergency room and outpatient visits, but shorter hospitalization (all p <.001) and lower mortality (HR = 0.85, 95% CI 0.80–0.93) than matched non-malnourished controls (N = 4788). Total medical expenditure on malnourished non-ventilator-dependent COPD patients was 75% higher than controls (p <.001), whereas malnourished ventilator-dependent patients had total costs 7% lower than controls (p <.001). Conclusions: Malnourishment among COPD patients who were not dependent on mechanical ventilation was associated with greater healthcare resource utilization and higher aggregate medical costs.

Original languageEnglish
Pages (from-to)1265-1273
Number of pages9
JournalCurrent Medical Research and Opinion
Volume35
Issue number7
DOIs
Publication statusPublished - Jul 3 2019

Fingerprint

Malnutrition
Chronic Obstructive Pulmonary Disease
Cohort Studies
Delivery of Health Care
Costs and Cost Analysis
Mortality
Hospitalization
Mechanical Ventilators
Artificial Respiration
Propensity Score
Hospital Emergency Service
Outpatients
National Health Programs
Health Expenditures
Taiwan
Respiratory Insufficiency
Economics
Health
Population

Keywords

  • chronic obstructive pulmonary disease (COPD)
  • cost
  • healthcare utilization
  • Malnutrition
  • mechanical ventilation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Healthcare utilization, medical costs and mortality associated with malnutrition in patients with chronic obstructive pulmonary disease : a matched cohort study. / Jerng, Jih Shuin; Tang, Chao Hsiun; Cheng, Rhoda Wen Yi; Wang, Michael Yao Hsien; Hung, Kuan Yu.

In: Current Medical Research and Opinion, Vol. 35, No. 7, 03.07.2019, p. 1265-1273.

Research output: Contribution to journalArticle

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abstract = "Objective: Although disease-related malnutrition has prognostic implications for patients with chronic obstructive pulmonary disease (COPD), its health-economic impact and clinical burdens are uncertain. We conducted a population-level study to investigate these questions. Methods: We excerpted data relevant to malnutrition, prolonged mechanical ventilation and medications from claims by 1,197,098 patients which were consistent with COPD and registered by the Taiwan National Health Insurance Administration between 2009 and 2013. These patients were separated into cohorts with or without respiratory failure requiring long-term mechanical ventilation, and each cohort was divided to compare cases who developed malnutrition after their first diagnosis consistent with COPD, versus non-malnourished propensity-score matched controls. Results: The prevalence of malnutrition was 3.8{\%} overall (10,259/287,000 non-ventilator-dependent; 1198/15,829 ventilator-dependent). Propensity-score matched non-ventilator-dependent patients who became malnourished (N = 10,242) had comparatively more hospitalizations, emergency room and outpatient visits, longer hospitalization (all p <.01), and higher mortality (HR = 2.26, 95{\%} CI 2.18–2.34) than non-malnourished controls (N = 40,968). Malnourished ventilator-dependent patients (N = 1197) had higher rates of hospitalization, emergency room and outpatient visits, but shorter hospitalization (all p <.001) and lower mortality (HR = 0.85, 95{\%} CI 0.80–0.93) than matched non-malnourished controls (N = 4788). Total medical expenditure on malnourished non-ventilator-dependent COPD patients was 75{\%} higher than controls (p <.001), whereas malnourished ventilator-dependent patients had total costs 7{\%} lower than controls (p <.001). Conclusions: Malnourishment among COPD patients who were not dependent on mechanical ventilation was associated with greater healthcare resource utilization and higher aggregate medical costs.",
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AU - Jerng, Jih Shuin

AU - Tang, Chao Hsiun

AU - Cheng, Rhoda Wen Yi

AU - Wang, Michael Yao Hsien

AU - Hung, Kuan Yu

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N2 - Objective: Although disease-related malnutrition has prognostic implications for patients with chronic obstructive pulmonary disease (COPD), its health-economic impact and clinical burdens are uncertain. We conducted a population-level study to investigate these questions. Methods: We excerpted data relevant to malnutrition, prolonged mechanical ventilation and medications from claims by 1,197,098 patients which were consistent with COPD and registered by the Taiwan National Health Insurance Administration between 2009 and 2013. These patients were separated into cohorts with or without respiratory failure requiring long-term mechanical ventilation, and each cohort was divided to compare cases who developed malnutrition after their first diagnosis consistent with COPD, versus non-malnourished propensity-score matched controls. Results: The prevalence of malnutrition was 3.8% overall (10,259/287,000 non-ventilator-dependent; 1198/15,829 ventilator-dependent). Propensity-score matched non-ventilator-dependent patients who became malnourished (N = 10,242) had comparatively more hospitalizations, emergency room and outpatient visits, longer hospitalization (all p <.01), and higher mortality (HR = 2.26, 95% CI 2.18–2.34) than non-malnourished controls (N = 40,968). Malnourished ventilator-dependent patients (N = 1197) had higher rates of hospitalization, emergency room and outpatient visits, but shorter hospitalization (all p <.001) and lower mortality (HR = 0.85, 95% CI 0.80–0.93) than matched non-malnourished controls (N = 4788). Total medical expenditure on malnourished non-ventilator-dependent COPD patients was 75% higher than controls (p <.001), whereas malnourished ventilator-dependent patients had total costs 7% lower than controls (p <.001). Conclusions: Malnourishment among COPD patients who were not dependent on mechanical ventilation was associated with greater healthcare resource utilization and higher aggregate medical costs.

AB - Objective: Although disease-related malnutrition has prognostic implications for patients with chronic obstructive pulmonary disease (COPD), its health-economic impact and clinical burdens are uncertain. We conducted a population-level study to investigate these questions. Methods: We excerpted data relevant to malnutrition, prolonged mechanical ventilation and medications from claims by 1,197,098 patients which were consistent with COPD and registered by the Taiwan National Health Insurance Administration between 2009 and 2013. These patients were separated into cohorts with or without respiratory failure requiring long-term mechanical ventilation, and each cohort was divided to compare cases who developed malnutrition after their first diagnosis consistent with COPD, versus non-malnourished propensity-score matched controls. Results: The prevalence of malnutrition was 3.8% overall (10,259/287,000 non-ventilator-dependent; 1198/15,829 ventilator-dependent). Propensity-score matched non-ventilator-dependent patients who became malnourished (N = 10,242) had comparatively more hospitalizations, emergency room and outpatient visits, longer hospitalization (all p <.01), and higher mortality (HR = 2.26, 95% CI 2.18–2.34) than non-malnourished controls (N = 40,968). Malnourished ventilator-dependent patients (N = 1197) had higher rates of hospitalization, emergency room and outpatient visits, but shorter hospitalization (all p <.001) and lower mortality (HR = 0.85, 95% CI 0.80–0.93) than matched non-malnourished controls (N = 4788). Total medical expenditure on malnourished non-ventilator-dependent COPD patients was 75% higher than controls (p <.001), whereas malnourished ventilator-dependent patients had total costs 7% lower than controls (p <.001). Conclusions: Malnourishment among COPD patients who were not dependent on mechanical ventilation was associated with greater healthcare resource utilization and higher aggregate medical costs.

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KW - cost

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KW - Malnutrition

KW - mechanical ventilation

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