International Journal of COPD (Sep 2021)

Impact of Lung Function and Exacerbations on Health-Related Quality of Life in COPD Patients Within One Year: Real-World Analysis Based on Claims Data

  • Stöber A,
  • Lutter JI,
  • Schwarzkopf L,
  • Kirsch F,
  • Schramm A,
  • Vogelmeier CF,
  • Leidl R

Journal volume & issue
Vol. Volume 16
pp. 2637 – 2651

Abstract

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Alisa Stöber,1,2 Johanna I Lutter,1,3 Larissa Schwarzkopf,1,3,4 Florian Kirsch,1 Anja Schramm,5 Claus F Vogelmeier,6 Reiner Leidl1,7 1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany; 2Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany; 3Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany; 4Institute fuer Therapieforschung (IFT), Working Group Therapy and Health Services Research, Munich, Germany; 5AOK Bayern, Service Center of Health Care Management, Regensburg, Germany; 6Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany; 7Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, GermanyCorrespondence: Alisa StöberInstitute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, 85764, GermanyTel +49 89 3187/43572Email [email protected]: Real-world evidence on the impact of forced expiratory volume in one second (FEV1) and exacerbations on health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) is sparse especially with regard to GOLD ABCD groups. This study investigates how changes in FEV1 and exacerbations affect generic and disease-specific HRQoL in COPD patients over one year.Methods: Using German claims data and survey data, we classified 3016 COPD patients and analyzed their health status by GOLD groups AB and CD. HRQoL was measured with the disease-specific COPD assessment test (CAT) and the visual analog scale (VAS) from the generic Euro-Qol 5D-5L. We applied change score models to assess associations between changes in FEV1 (≥ 100 mL decrease/no change/≥ 100 mL increase) or the development of severe exacerbations with change in HRQoL.Results: FEV1 decrease was associated with a significant but not minimal important difference (MID) deterioration in disease-specific HRQoL (mean change [95% CI]: CAT +0.74 [0.15 to 1.33]), while no significant change was observed in the generic VAS. Experiencing at least one severe exacerbation also had a significant impact on CAT deterioration (+1.58 [0.52 to 2.64]), but again not on VAS. Here, GOLD groups AB showed not only a statistically but also a clinically relevant MID deterioration in CAT (+2.1 [0.88 to 3.32]). These particular patient groups were further characterized by a higher probability of being male, having a higher mMRC and Charlson index, and a lower probability of having higher FEV1 or BMI values.Conclusion: FEV1 decline and the occurrence of ≥ 1 severe exacerbation are significantly associated with overall deterioration in disease-specific HRQoL. Preventing severe exacerbations particularly in patients without previous severe exacerbations (ABCD groups A and B) may help to stabilize the key patient-reported outcome HRQoL.Keywords: COPD, health-related quality of life, longitudinal study, real-world evidence, forced expiratory volume in 1 second, exacerbation

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