International Journal of COPD (Oct 2022)
A 4-Year Retrospective Claims Analysis of Oral Corticosteroid Use and Health Conditions in Newly Diagnosed Medicare FFS Patients with COPD
Abstract
Carol Bazell,1 Michael Pollack,2 Alejandro P Comellas,3 Sanjay Sethi,4 Maggie Alston,1 Bruce Pyenson,1 Dane Hansen,1 Melissa Caplen,1 Anthony Staresinic,2 John Styczynski,2 Norbert Feigler2 1Milliman, New York, NY, USA; 2BioPharmaceuticals, US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 3Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; 4Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USACorrespondence: Michael Pollack, BioPharmaceuticals, US Medical Affairs, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA, Tel +1 302 886 1253, Email [email protected]: We analyzed population-level administrative claims data for Medicare fee-for-service (FFS) beneficiaries to provide insights on systemic oral corticosteroid (OCS) use patterns and associated health conditions and acute events among patients newly diagnosed with chronic obstructive pulmonary disease (COPD).Background: COPD is a progressive inflammatory disease of the lungs, characterized by acute exacerbations that may lead to increased mortality. Short courses of systemic corticosteroids (SCS) are recommended to reduce recovery time from exacerbations, although SCS use has been associated with increased risk of adverse events.Methods: This study used 2013– 2019 Medicare 100% FFS research identifiable files, which contain all Medicare Parts A, B, and D paid claims incurred by 100% of Medicare FFS beneficiaries. Descriptive statistics for patients newly diagnosed with COPD were analyzed, including OCS use, select health conditions and acute events, and COPD exacerbations. Statistical models were used to analyze the relationship between the incidence of select health conditions and events and cumulative OCS dosage.Results: Of Medicare FFS patients newly diagnosed with COPD, 36% received OCS in the 48 months following diagnosis, and 38% of OCS episodes lasted longer than the recommended 5– 7 days. Patients had a variety of health conditions or acute events in the 24-month period prior to new COPD diagnosis, such as hypertension, depression/anxiety, type 2 diabetes, or osteoporosis, that could heighten the risks of OCS use. Patients treated with > 1000 mg of prednisolone equivalent OCS in the 48 months following COPD diagnosis had a higher incidence of new conditions or events, including cardiovascular disease, heart failure, hypertension, obesity, dyspepsia, infections, and depression/anxiety, than patients with no OCS use.Conclusion: These results highlight the potential risks of OCS in COPD treatment, including prolonged use among complex Medicare patients, and reinforce the importance of preventive treatment strategies and therapy optimization early in the disease course.Keywords: chronic obstructive pulmonary disease, systemic corticosteroids, SCS, OCS, COPD exacerbations, claims analysis
