$36B in COPD Hospitalizations: How Can We Do Better?

I. Overview

Chronic obstructive pulmonary disease, or COPD as it is commonly referred to, is a debilitating illness caused by recurrent damage to the respiratory tract and lungs. The typical COPD patient has a long time history of smoking, struggles with shortness of breath, and progressive deterioration of activities of daily living, and with over 12 million adults living with COPD, the CDC estimates the total economic burden in the United States to be greater than $36B this year, on track to reach $49B by the year 2020 (1). To put this in perspective, discretionary spending on Veterans’ Benefits in 2015 totaled $65.3B. While the economic of COPD are apparent, this disease often takes serious physical and mental tolls on patients as well, with many COPD patients struggling with subsequent depression and loneliness (2).

A hallmark of COPD is the development of acute periods of symptom exacerbation in which patients experience large deviations in their baseline breathing. 50-75% of COPD-related healthcare expenditures are the result of exacerbations and the hospitalizations that they result in (3). Reducing COPD-related hospitalizations is a critical focus of healthcare providers and payers alike as COPD is one of top five most common causes of re-hospitalization in the US (4).

II. Current standard of care

Patients with COPD should be seen regularly by their primary care provider or referred to a pulmonologist to evaluate their symptoms and assess the need for changes in their plan of care. Treatment for COPD includes the use of short and long acting respiratory inhalers, in-home oxygen use, and high dose steroids to reduce inflammation during periods of acute exacerbation. Patients with COPD are at higher risk for respiratory tract infections and are frequently prescribed antibiotics to treat these as they arise (3).

Lungs

III. How to treat patients at home

The current COPD treatment paradigm leaves large gaps in time–the time between when a patient visits his or her physician in clinic–when a patient can experience preventable exacerbation events, but no mechanism is currently in place to catch these events. A mobile health system designed to regularly track patients’ breathing status and alert physicians when patients are doing poorly has the potential to transform the current standard of care for all COPD patients.

Epharmix has developed just such a system. EpxCOPD contacts patients every day with a phone call or text message asking them if they are breathing better, worse, or the same then the day prior. If a patient reports breathing worse, an electronic alert is immediately sent to that patient’s designated provider and the provider can administer the appropriate follow up care.

IV. Achieving symptom control through Epharmix

The EpxCOPD system has now been extensively tested in both a pilot study and an ongoing randomized controlled trial at Washington University School of Medicine. Interim results show that our system works to meet the needs of both patients and their physicians. Patients appreciate regular contact with their physician and benefit from a daily reminder to think about their current state of health. Physicians benefit from a system that essentially auto triages their patients, enabling them to spend more time focused on the patients who most need their attention.

Our vision is to permanently shift the COPD treatment paradigm away from point to point care and towards an affordable, simple, and continuous monitoring system. We now possess the tools to transform COPD treatment, reduce patients’ disease burden, and cut the costs of COPD-related hospitalizations on our healthcare system.

Eric Sink

Saint Louis University School of Medicine Class of 2019

Clinical Researcher, Washington University in St. Louis

Advisors: Dr. Will Ross and Dr. Melvin Blanchard.

Citations

  1. CHEST American College of Chest Physicians. “CDC Reports Annual Financial Cost of COPD” http://www.chestnet.org/News/Press-Releases/2014/07/CDC-reports-36-billion-in-annual-financial-cost-of-COPD-in-US
  2. Depression and COPD, management and quality of life considerations. Stage KB, Middelboe T, Stage TB, Sorenson CH. Int J Chron Obstruct Pulmon Dis. 2006; 1(3): 315-320.
  3. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med. 1995; 152:S77.
  4. The Advisory Board Company. Playbook for reducing COPD readmissions. 2015.

Image Source: http://www.thesleuthjournal.com/wp-content/uploads/2015/05/COPD.jpg