Non-CF Bronchiectasis Linked to High Medicare Use and Spending

Newly diagnosed non-cystic fibrosis bronchiectasis (non-CF BE) among Medicare beneficiaries was associated with high health care use across multiple settings, highlighting opportunities for improved care coordination.¹ Older adults and women make up a significant majority of this population.²

A retrospective cohort study using 100% US Medicare enrollment, fee-for-service (FFS) claims, and Medicare Advantage (MA) encounter data found that incident non-CF BE in Medicare beneficiaries was associated with substantial all-cause utilization across inpatient, emergency department, outpatient, and post-acute settings.¹ Claims and encounter data between January 1, 2016, and December 31, 2023, were used in the analysis.¹ Using the same data sources, researchers also set out to find the overall prevalence of non-CF BE in 2023 by coverage type, age group, sex, and state.²

Both studies identified non-CF BE using a claims-based definition of at least 1 inpatient claim or at least 2 outpatient claims 7 or more days apart within 365 days with ICD-10-CM diagnosis codes J47.x or Q33.4.^1,2 In the cohort study, eligible beneficiaries were aged 18 years or older with continuous enrollment in Medicare Parts A/B (FFS) or Part C (MA) plus Part D for 12 months pre-index date. Patients with a lung transplant prior to the index date or with cystic fibrosis were excluded from the study.¹ Beneficiaries with cystic fibrosis were also excluded from the prevalence study.²

Non-CF Bronchiectasis Linked to High Medicare Utilization and Spending

Between 2017 and 2022, 600,841 beneficiaries were identified with incident non-CF BE and included in the analysis (FFS: 287,022 [47.8%]; MA: 313,819 [52.2%]). The mean age was 75.9 years, with 92.3% older than 65 years; 61.0% of all beneficiaries included were female.¹

Mean follow-up, starting from the index date, was 32.9 months. Throughout the follow-up period, inpatient hospitalization occurred in 66.2% of FFS and 61.2% of MA beneficiaries. Emergency department use occurred in 78.5% of FFS and 77.0% of MA beneficiaries. Outpatient facility use (91.4% FFS; 88.5% MA) and durable medical equipment use (70.1% FFS; 61.3% MA) were also common.¹

The mean total spending among FFS beneficiaries, combined medical and pharmacy, during follow-up was $8998 (SD, $22,635) per person per month (PPPM), adjusted for inflation to 2023 US dollars. The major contributors to FFS spending included inpatient hospitalization ($4968 [SD, $19,465] PPPM), Part D outpatient pharmacy ($854 [SD, $2405] PPPM), and carrier/physician services ($1483 [SD, $3258] PPPM).¹

“Newly diagnosed non-CF BE is linked to high healthcare use across multiple settings and (in FFS) substantial spending during follow-up, underscoring opportunities to improve care coordination and reduce acute-care dependence in routine practice,” the study authors wrote.¹

Non-CF Bronchiectasis Prevalence Rises With Age, Higher Among Women

The second study found that in 2023, 535,038 beneficiaries across FFS and MA met the non-CF BE definition. Their mean age was 76.0 years, with more than 90% aged 65 years and older, and 64.1% were female. The total number of eligible beneficiaries, 53,267,186, was used to calculate an overall crude, unstandardized prevalence for non-CF BE of 1004 per 100,000 person-years (95% CI, 1002-1007).²

For FFS, the prevalence was 929 per 100,000 person-years and 1061 per 100,000 person-years for MA. The data showed a trend of prevalence increasing with age and being higher among females than males within each age group.²

“These findings highlight a substantial non-CF BE burden in older adults and females, along with sizable geographic variation, supporting targeted care planning and sex- and state-specific evidence generation for non-CF BE in the Medicare population,” the study authors concluded.²

Both abstracts are scheduled to be presented at the CHEST 2026 Annual Meeting in Phoenix, Arizona, from October 18-21.

References

1. Kharat A, Marcum Z, Epstein A, et al. Health care resource utilization and costs among Medicare beneficiaries with incident noncystic fibrosis bronchiectasis. Presented at: CHEST 2026 Annual Meeting; October 18-21, 2026; Phoenix, AZ.

2. Kharat A, Marcum Z, Epstein A, et al. Prevalence of noncystic fibrosis bronchiectasis among Medicare beneficiaries by state in the United States. Presented at: CHEST 2026 Annual Meeting; October 18-21, 2026; Phoenix, AZ.