Costs, health care utilization rise after patients with COPD become frequent exacerbators
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Key takeaways:
- Of 156,462 patients with GOLD A/B COPD, 45,079 progressed to GOLD E during follow-up.
- Researchers observed higher COPD-related total annualized costs after vs. before progression to GOLD E.
BOSTON — After progressing to Global Initiative for Chronic Obstructive Lung Disease, or GOLD, group E, patients with COPD faced higher costs and used health care resources more, according to a poster presented at the CHEST Annual Meeting.
“COPD-related costs more than doubled with progression to GOLD E, pointing to the significant economic impact of exacerbations and the need to prevent frequent or severe events,” Sanjay Sethi, MD, professor and chief of pulmonary, critical care and sleep medicine, as well as assistant vice president for health sciences at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and colleagues wrote on the poster.
Sethi and colleagues assessed 156,462 adults with COPD starting a new inhaled maintenance medication via Optum’s Clinformatics Data Mart database of U.S. individuals on Medicare or commercial insurance plans to find out how patients originally grouped in GOLD A/B (less than two moderate exacerbations in 12 months prior to starting new maintenance medication) change after progressing to GOLD E (two moderate or one severe exacerbation 1 year after starting new maintenance medication) in terms of costs and health care resource utilization.
Almost half of the total cohort (47%) had been prescribed long-acting beta-2 agonist/inhaled corticosteroid. Other inhaled COPD maintenance medications were prescribed to smaller proportions of patients, including LAMA alone (19%), long-acting muscarinic antagonist/LABA (19%), LABA/LAMA/ICS (14%) and LABA alone (1%).
Within the total cohort of patients with GOLD A/B COPD, researchers found that 45,079 progressed to GOLD E during follow-up (mean, 232 days), of which 5,777 had data 12 months before and 12 months after progression for analysis.
“Despite use of inhaled COPD maintenance treatments, over 50% of patients progressed to a frequently exacerbating status over 5 years,” Sethi and colleagues wrote.
In the 12 months before progression to GOLD E, $3,740 was the mean COPD-related total annualized costs, whereas in the 12 months after progression, these costs went up to $9,990 (P < .001), according to the poster.
Following a similar pattern, researchers observed higher COPD-related medical costs after vs. before progression to GOLD E (mean, $4,850 vs. $829; P < .001), and the same was true when capturing all-cause total annualized costs (mean after, $58,700 vs. before, $39,800; P < .001).
Health care resource utilization related to COPD was divided into four categories: ED visits, inpatient/skilled nursing facility admissions, office visits and outpatient visits.
The proportion of patients with office visits was elevated before progressing to GOLD E at 64% and grew to 71% after progressing to GOLD E. When assessing outpatient visits, more patients used this resource after vs. before progression to GOLD E (37% vs. 22%), according to the poster.
Notably, no patients had ED visits before progressing to GOLD E, but after this GOLD grade change, 20% of patients experienced this type of visit. Similarly, researchers reported that the proportion of patients with an inpatient/skilled nursing facility admission rose from 0.4% before GOLD E progression to 11% after GOLD E progression.
“New COPD therapies are needed that may help to prevent a broad population of patients with COPD from progressing to GOLD E,” Sethi and colleagues wrote.