Clinical And Economic Burden Of Eosinophilic COPD In A Large Retrospective US Cohort

Abstract

Purpose

We sought to describe clinical and economic outcomes for COPD patients by blood eosinophil (EOS) count.

Methods

This retrospective cohort study of COPD patients used data from the Practice Fusion electronic medical records (EMR) database linked to Symphony Health Solutions transactional pharmacy, medical, outpatient, and inpatient claims data to evaluate COPD-related and all-cause health care resource utilization and cost in the 12-month period following the date of each patient’s greatest recorded blood eosinophil count during the 27-month period from January 2014 to March 2016. A post-index moderate exacerbation was defined as an outpatient or emergency care visit for COPD and a prescription for oral corticosteroid and/or antibiotics within 10 days of the visit. Severe exacerbation was defined as an inpatient hospitalization with COPD as primary diagnosis.

Results

Of 48,090 EMR patients, 39,939 (83.1%) had a charge in the claims data both pre- and post-index (mean age 67.2 years, 58.3% female), 17,397 (43.6%) had EOS ≥220 cells/µL. Moderate and severe exacerbations were more frequent for patients with EOS≥220 cells/µL compared with those with EOS <220 cells/µL (moderate: 6.8% vs 6.1%, p<0.05; severe: 3.1% vs 2.5%, p<0.001). After adjustment for baseline clinical characteristics, each 100-unit increase in EOS count was associated with a significant 2.24% increase in total all-cause costs and 4.54% increase in total COPD-related costs (p<0.001 for both). COPD-related costs were significantly greater for patients with an EOS count of ≥220 cells/µL compared with those with EOS <220 cells/µL (p<0.001). These costs appear to have been driven by a greater percentage of patients in the ≥220 cells/µL cohort with COPD-related resource use including hospitalization, office visits, ambulatory procedures and pharmacy prescriptions.

Conclusion

COPD patients with EOS counts ≥220 cells/µL were more likely to have had moderate or severe exacerbations and greater cost of care than those with EOS <220 cells/µL.

Keywords:

• clinical phenotypes
• electronic medical records
• exacerbations
• health care resource utilization
• eosinophils

Acknowledgments

This study was funded by AstraZeneca through a contract with Veradigm Health. The abstract of this paper was presented at the CHEST Annual Meeting 2018 as a poster presentation with interim findings. The poster’s abstract was published in “CHEST 2018 Annual Meeting Abstracts” CHEST Volume 154, Issue 4, Supplement, Pages 753A–754A: https://doi.org/10.1016/j.chest.2018.08.679.

Author Contributions

All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version for publication, and agree to be accountable for all aspects of the work.

Disclosure

FT and YC are employees of AstraZeneca. LK, JV, AW, LS, and DO are employees of Practice Fusion, a division of Veradigm Health, which received funding from AstraZeneca to conduct the study. CS is a consultant for AstraZeneca, Glaxo Smith Kline, and Uptake Medical on the topic of COPD. CS has grants from the Alpha-1 Foundation, BTG, CSL Behring, Grifols, Novartis, Shire and Vertex in COPD. CS also reports personal fees, non-financial support from AstraZeneca and GlaxoSmithKline, non-financial support from Boehringer Ingelheim and grants from Novartis, outside the submitted work. The authors report no other conflicts of interest in this work.