The Quality of Care and Economic Burden of COPD in the United States: Considerations for Managing Patients and Improving Outcomes

BACKGROUND: The economic and societal burdens of chronic obstructive pulmonary disease (COPD) in the United States are substantial and increasing. COPD had projected US costs of $49 billion in 2020, and chronic lower respiratory diseases, including COPD, were the fourth leading cause of death in the United States in 2019. COPD-related hospitalizations for exacerbations are the greatest driver of costs; however, numerous factors shape the current landscape of COPD, and thus multiple opportunities to improve quality of care for patients are being explored. OBJECTIVES: To describe the existing burden, unmet needs, and related economics of COPD in relation to quality of care and to discuss approaches to reduce the cost of managing COPD, including advancements in maintenance therapy. DISCUSSION: Comorbidities are associated with increased hospitalizations and costs, worse outcomes, and reduced quality of life in patients with COPD. The severity of COPD and the rate of exacerbations are important drivers of medical costs, which highlights the importance of early diagnosis, early recognition of exacerbations, and timely initiation of therapy. The reduction of COPD hospital readmissions is of critical importance to reduce costs, per the recommendations of organizations such as the Centers for Medicare & Medicaid Services. Performance measures offered by the Healthcare Effectiveness Data and Information Set are a helpful tool; however, objective data evaluating how improving the quality of COPD care translates to reduced costs to the healthcare system are lacking. CONCLUSION: A comprehensive strategy to reduce COPD mortality and clinical burden will require a multifaceted approach. Key methods include improved patient access to care; early intervention with appropriate, effective treatment, such as single-inhaler triple therapies; proactive adherence monitoring; early recognition of worsening COPD and modification of treatment; disease management strategies, including smoking cessation and pulmonary rehabilitation; and evidence-based metrics to evaluate hospital readmission programs.