Predicting Medical Expenses in COPD Using the DOSE Index and Charlson Comorbidity index

Abstract

Background:

The DOSE index is an invaluable instrument for evaluating both the severity and prognosis of COPD, encompassing elements such as dyspnea, obstruction, smoking, and exacerbations (DOSE) within a thorough patient assessment. In addition to its conventional role in assessing risks, the DOSE index demonstrates significant clinical value by predicting healthcare costs. Given the absence of specialized indices for forecasting medical expenditures, our research focused on examining the correlation between the DOSE index and medical expenses as measured by the Charlson Comorbidity Index (CCI) in COPD.

Methods:

This retrospective study analyzes data from 396 COPD cases, examining the DOSE index, BODE index, ADO index, CCI, medical expenses, hospitalizations, and emergency room treatments. Baseline characteristics are expressed as the mean and standard deviation (mean ± SD), median (interquartile range, IQR), or n (%). The distributions of DOSE and CCI were evaluated by descriptive statistical analysis. DOSE quartiles and two CCI groups by Chi-square. Fisher’s exact test, and one-way analysis of variance (one-way ANOVA) were applied to compare the differences in variables by quartiles, and then posteriori comparisons were made using Scheffes test.

Results:

Significant associations were discovered between the DOSE index and the CCI in patients with COPD (P < .001). Of the 396 COPD patients meeting inclusion criteria, 382 (96.5%) were male, with an average age of 71.3 ± 8.4 y. Various healthcare parameters showed significant associations with the DOSE index. Notably, DOSE quartiles exhibited meaningful correlations with outpatient visits (P = .01) and outpatient medical expenses (P = .01). Additionally, substantial correlations were observed with hospitalization frequency, duration, and associated expenses (P < .001).When categorizing CCI into high (CCI ≥ 3) and low (CCI < 3) levels, a statistically significant difference was found when comparing DOSE quartiles between these groups with total medical expenses (P < .001).

Conclusions:

The findings underscore the DOSE index and CCI potential in predicting medical expenses, extending its application beyond traditional risk assessment in COPD management. This study contributes valuable insights to the development of tools for forecasting healthcare expenses in COPD patients.

Total medical expenses by DOSE quartiles for the high CCI and low CCI groups. Patients with high CCI level had higher total medical expenses than those with low CCI level after adjusting for DOSE quartiles (p < 0.001).