Treatment cost of acute exacerbations of chronic bronchitis

In 1994, the National Center for Health Statistics estimated that more than 14 million people (54 per thousand) had chronic bronchitis and sought trea tment for 90.9% of their acute episodes. However, few studies have been don e on the treatment cost of chronic bronchitis using national data. We condu cted a retrospective analysis of claims for patients treated for acute exac erbations of chronic bronchitis (AECB) to assess the frequency of services rendered and the costs to the health care system. Records were selected for the study based on a primary diagnosis of AECB according to the Internatio nal Classification of Diseases, Ninth Revision, code. Medicare was the prim ary source of data on patients aged greater than or equal to 65 years; data from the National Healthcare and Cost Utilization Project, the National Am bulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey were used for patients aged <65 years. We calculated a total tr eatment: cost of $1.2 billion for patients aged greater than or equal to 65 years and $419 million for patients aged <65 years. These calculations wer e based on the following: 280,839 hospital discharges resulting in hospital costs of $1.1 billion for the 207,540 patients aged greater than or equal to 65 years, and $408 million for the 73,299 patients aged <65 years. The m ean hospital length of stay was 6.3 days with a mean cost of $5497 for pati ents aged greater than or equal to 65 years and 5.8 days with a mean cost o f $5561 for younger patients. Room and board represented the largest percen tage of the mean hospital costs of AECB. Inpatient physician services cost $32 million and $11 million for the 2 age groups, respectively. Diagnosis-s pecific data for outpatient services were found to be less reliable than in patient data, possibly due to diagnostic coding omissions; 331,000 outpatie nt office visits for AECB were found for those aged greater than or equal t o 65 years and 237,000 visits for those aged <65 years, resulting in respec tive total outpatient costs of $24.9 million and $15.1 million. If the numb er of outpatient visits remain consistent with 1994 levels, there would be 5.8 million visits annually for those aged greater than or equal to 65 year s and 4.2 million visits for those aged <65 years; total outpatient costs w ould be $452 million and $317 million, respectively. Because the treatment costs of AECB are largely the costs of hospitalization, any new therapy tha t allows more patients to be treated in the outpatient setting is likely to generate significant savings.