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Facing the challenges of COPD: A review of the state of COPD care in the U.S

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Published on Jul 13, 2022

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This white paper represents the views of the author, not America’s Health Insurance Plans (AHIP). The publication, distribution or posting of this white paper by AHIP does not constitute a guaranty of any product or service by AHIP.

COPD management costs are on the rise

Although medical diagnostics, therapeutics, and care guidelines have been developed to treat chronic obstructive pulmonary disease (COPD), the costs of managing and treating these patients continue to rise. The challenges of treatment are complex.

An estimated 29 million Americans are living with COPD, but only 13 million Americans have been diagnosed with this obstructive lung disease that compromises quality of life and longevity. Many who have been diagnosed do not know the specifics of their disease or understand its severity. Patients struggle not only with the disease itself, but also with the challenges of obtaining care. These difficulties are compounded by socioeconomic disparities.

Significant barriers to delivering optimal care for this patient population include the high rate of underdiagnosis and challenges in accessing specialty care and critical medications.

COPD is also characterized by exacerbations that are a significant driver of morbidity, mortality, and cost.

COPD exacerbations accounted for 1.8 million emergency department visits in 2012; an estimated 20% of those became hospitalizations. The COPD burden in the US is estimated at around $49 billion a year. Exacerbations of COPD account for up to 75% of total direct disease cost. Private insurance paid 18% of those costs; Medicare and Medicaid paid 51% and 25% respectively.

The COVID-19 pandemic has introduced new risks for COPD members and additional management challenges to maintain treatment while avoiding exposure to the virus.