Costs and Clinical Consequences of Compliance with COPD GOLD Recommendations or National Guidelines Compared with Current Clinical Practice in Belgium, Germany, Sweden, and the United States

Abstract

Sanjay Sethi,1 Antony Wright,2 Elisabeth Sophia Hartgers-Gubbels,3 Marlene Hechtner,3 Brendan Clark,4 Ciara Wright,2 Sue Langham,2 Roland Buhl5 1Pulmonary/Critical Care/Sleep Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA; 2Maverex Ltd., Newcastle Upon Tyne, NE6 2HL, UK; 3Boehringer Ingelheim GmbH, Ingelheim Am Rhein, Germany; 4Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 5Pulmonary Department, Mainz University Hospital, Mainz, GermanyCorrespondence: Antony Wright, Maverex Ltd, Newcastle Upon Tyne, NE6 2HL, UK, Tel [phone], Email [email protected]: The objective of this study was to assess the clinical and cost benefits of treating patients with chronic obstructive pulmonary disease (COPD) according to global and national guidelines compared to real-life clinical practice in the United States and three European countries (Belgium, Germany, Sweden).Patients and Methods: A cost-consequence model was developed to compare current prescribing patterns with two alternative scenarios, the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2022) recommendations and the second with national guidelines. Costs and clinical outcomes were modeled for these alternative scenarios over a time horizon of one year, based on real-world evidence and health insurance data.Results: Current clinical practice in each of the countries was inconsistent with published recommendations. A redistribution to prescribing patterns according to global and national recommendations led to a substantial decrease in the use of inhaled corticosteroid (ICS) containing therapies of more than 80% and 44%, respectively. There was a reduced incidence of up to 16% of mild-to-moderate pneumonia and up to 29% of severe pneumonia. Exacerbations decreased across all countries apart from Sweden, where a small increase in the rate of exacerbations was due to the redistribution of some patients currently undergoing inhaled triple therapy to non-ICS-containing therapies. Adapting treatment to recommendations could provide potential cost savings of up to 13% in estimated annual direct costs, resulting predominantly from the reduction in cost of healthcare resource use, including hospitalization associated with treating incident pneumonia, particularly severe pneumonia. Cost savings for prevalent adult patients with COPD on long-acting inhaler therapy ranged from € 31 to € 675 per patient per year.Conclusion: Redistribution of COPD patients from current clinical practice to treatment according to published recommendations would provide clinical benefits and substantial cost savings.Keywords: chronic obstructive pulmonary disease, guideline adherence, healthcare costs, maintenance inhaler therapy

Keywords

• chronic obstructive pulmonary disease
• guideline adherence
• healthcare costs
• maintenance inhaler therapy