Trends in Hospitalization Expenditures for Acute Exacerbations of COPD in Beijing from 2009 to 2017

Abstract

Lirong Liang,1 Yunxiao Shang,2 Wuxiang Xie,3 Julie Shi,2 Zhaohui Tong,4 Mohammad S Jalali5 1Department of Clinical Epidemiology & Tobacco Dependence Treatment Research, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2School of Economics, Peking University, Beijing, People’s Republic of China; 3Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 5MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USACorrespondence: Julie Shi; Zhaohui Tong Tel [phone]; Tel [phone]Email [email protected]; [email protected]: Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We investigated trends in hospitalizations for acute exacerbation of COPD in Beijing, China, from 2009 to 2017.Patients and Methods: Investigations were conducted using data from the discharge records of inpatients that were given a primary diagnosis of acute exacerbation of COPD. The dataset was a retrospective review of information collected from electronic medical records and included 315,116 admissions (159,368 patients). Descriptive analyses and multivariate regressions were used to investigate trends in per admission and per capita expenditures, as well as other potential contributing factors.Results: The mean per admission expenditures increased from 19,760 CNY ($2893, based on USD/CNY=6.8310) in 2009 to 20,118 CNY ($2980) in 2017 (a growth rate of 0.11%). However, the per capita expenditures increased from 23,716 CNY ($3472) in 2009 to 31,000 CNY ($4538) in 2017 (a growth rate of 1.7%). In terms of per admission expenditures, drug costs accounted for 52.9% of the total expenditures in 2009 and dropped to 39.4% in 2017 (P trend < 0.001). The mean length of stay (LOS) decreased from 16.0 days to 13.5 days (P trend < 0· 001). Age, gender, COPD type, LOS, and hospital level were all associated with per admission and per capita expenditures.Interpretation: Relatively stable per admission expenditures along with the decline in drug costs and LOS reflect the effectiveness of cost containment on some indicators in China’s health care reform. However, the increase in hospitalization expenditures per capita calls for better policies for controlling hospitalizations, especially multiple admissions.Keywords: hospitalization expenditures, acute exacerbation of chronic obstructive pulmonary disease, trend analysis

Keywords

• hospitalization expenditures
• acute exacerbation of chronic obstructive pulmonary disease
• trend analysis