Eosinophil counts in first COPD hospitalizations: a 1-year cost analysis in Quebec, Canada

Abstract

Background

Exacerbations explain much of the cost of COPD. Higher blood eosinophil cell counts at admission for acute exacerbation of COPD increase the risk of subsequent exacerbations and hospitalizations. However, there is no literature on the economic burden of patients with this inflammatory profile. The objective of this study is to assess the cost of health-care service utilization according to different counts of blood eosinophils.

Methods

The observational retrospective cohort included all first hospitalizations for COPD exacerbation between April 2006 and March 2013. The eosinophilic group was defined by blood eosinophil counts on admission ≥200 cells/µL and/or ≥2% of the total white blood cell count. Study outcomes were: total costs (2016 Canadian dollars) (index hospitalization and 1-year follow-up), total index hospitalization costs, total 1-year costs (all-cause readmissions, ambulatory and emergency service use), and 1-year COPD-related costs (only cost for COPD after initial discharge). Sensitivity analyses were conducted to evaluate the impact of different eosinophil cut-offs on outcomes.

Results

In total, 479 patients were included, 173 in the eosinophilic group (92 in the higher cut-off). The average total cost was $18,263 ($6,706 for the index hospitalization), without significant difference between groups (P=0.3). The average 1-year COPD-related cost was higher in the eosinophilic group ($3,667 vs $2,472, P=0.006), with an adjusted mean difference of $1,416. Analysis of data using the higher cut-off of ≥400 cells or ≥3% was associated with a slightly larger difference in 1-year COPD-related costs between groups ($4,060 vs $2,629, P=0.003), with an adjusted mean difference of $1,640.

Conclusion

A higher blood eosinophil cell count at admission for a first hospitalization is associated with an increase in total 1-year COPD-related costs.

Keywords:

• chronic obstructive pulmonary disease
• exacerbations
• health-care utilization
• cohort study
• Canada
• Quebec

Supplementary materials

Table S1 Cost for hospitalization, emergency and ambulatory medical services at index hospitalization and 1-year follow-up

Table S2 Comparison of categorized costs according to eosinophilia group

Acknowledgments

This study was conducted with funding support from AstraZeneca Canada Inc.

Disclosure

AV and TGP report grants from AstraZeneca Canada Inc, during the conduct of the study; PL reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, and Novartis, grants from Sanofi, and personal fees from Merck, outside the submitted work. The authors report no other conflicts of interest in this work.