Relationship of COPD Exacerbation Severity and Frequency on Risks for Future Events and Economic Burden in the Medicare Fee-For-Service Population

Abstract

Sanjay Sethi,1 Barry J Make,2 Scott B Robinson,3 Shambhavi Kumar,3 Michael Pollack,4 Chad Moretz,5 Jill Dreyfus,5 Ann Xi,5 Dakota Powell,5 Norbert Feigler4 1University at Buffalo, Buffalo, NY, USA; 2National Jewish Health, Denver, CO, USA; 3Avalere, Health Economics and Advanced Analytics, Washington, DC, USA; 4AstraZeneca, Biopharmaceuticals Medical, Wilmington, DE, USA; 5Formerly Avalere, Washington, DC, USACorrespondence: Michael Pollack, Health Economics and Payer Evidence-Global, 1800 Concord Pike, Wilmington, DE, 19850, USA, Tel [phone], Email [email protected]: To quantify the effects of moderate and/or severe chronic obstructive pulmonary disease (COPD) exacerbations on future exacerbations and healthcare costs in Medicare Fee-For-Service beneficiaries.Patients and Methods: A retrospective cohort study of patients ≥ 40 years of age, with continuous enrollment from 2015 to 2018, with an index COPD diagnosis defined as first hospitalization, emergency department visit, or first of two outpatient visits (≥ 30 days apart) in 2015 with a claim for chronic bronchitis, emphysema, or chronic airway obstruction. Patients were stratified by baseline exacerbation categories in year one (YR1) and subsequently evaluated in YR2 and YR3: (A) none; (B) 1 moderate; (C) ≥ 2 moderate; (D) 1 severe; and (E) ≥ 2, one being severe. Moderate exacerbations were defined as COPD-related outpatient/ED visits with a corticosteroid/antibiotic claim within ± 7 days of the visit and severe exacerbations as hospitalizations with a primary COPD diagnosis. Total all-cause costs for Categories B-E were compared to reference Category A using generalized linear models and inflation adjusted to 2019 dollars.Results: A total of 1,492,108 patients met study criteria with a mean (±SD) age of 70.9± 10.9. In YR1, nearly 40% of patients experienced ≥ 1 moderate and/or severe exacerbations. Patients having multiple exacerbations, regardless of severity were 2– 4 times more likely to experience an exacerbation during YR2 and YR3. Adjusted costs ranged between $24,000 and $26,600 for all categories for YR2 and YR3. Adjusted YR2 costs for Category D and E were $1421 and $1548 higher than those without an exacerbation (Category A YR2 $25,084, YR3 $24,282; p< 0.0001). The respective YR3 adjusted costs were $2062 and $2117 higher than those without an exacerbation (Category A; p< 0.0001), representing an increase of 6– 8% and 8– 9% for YR2 and YR3.Conclusion: Medicare patients with recent moderate or severe exacerbations, or at least two exacerbations per year are at significant risk for future exacerbations and incur higher all-cause costs.Keywords: chronic obstructive pulmonary disease, exacerbations, medicare, maintenance therapy, costs

Keywords

• chronic obstructive pulmonary disease
• exacerbations
• medicare
• maintenance therapy
• costs