Rising total costs and mortality rates associated with admissions due to COPD exacerbations

Nicolas Molinari, Pascal Chanez, Nicolas Roche, Engi Ahmed, Isabelle Vachier, Arnaud Bourdin

To examine trends in mortality, costs and in-hospital management and outcomes of severe COPD exacerbations admitted in France. Patients hospitalized from 2007 to 2012 with COPD exacerbation as the primary diagnosis were identified from the exhaustive French medico-administrative hospitalizations database records. Four groups of severe COPD exacerbations were defined: hospitalisation in a general ward (GW) without acute respiratory failure (ARF), GW with ARF, ICU without invasive mechanical ventilation (MV), and ICU with MV. A 15.48 % increase in admissions from 113 276 in 2007 to 133 497 in 2012 was recorded. Age (+9.9 months), gender (-2.5 % of male) and length of stay (-0.29 day) slightly changed while the number of ICU admissions increased markedly (+41.78 %). In-hospital mortality rates increased (+8.06 %, p < .001) and followed seasonal variations peaking in winter. Total hospitalizations costs increased from 602 to 678 millions euros (+12.6 %). Pneumonia-related mortality increased (+37.2 %). A progressive replacement of chest X-ray by CT scan was observed (-41.3 % vs +31.7 %) while fewer spirometries (-13.7 %) and bronchoscopies (-22.6 %) were performed. The incidence of severe COPD exacerbations and the proportion of ICU-managed patients are still increasing in France. Rising total costs and mortality rates especially related to pneumonia advocate for rethinking COPD management plans. Not applicable.