Clinical Impact and Healthcare Resource Utilization Associated with Early versus Late COPD Diagnosis in Patients from UK CPRD Database

Abstract

Purpose

Previous studies have shown that opportunities to diagnose chronic obstructive pulmonary disease (COPD) early are often missed in primary care. This retrospective study aimed to utilize secondary data from the United Kingdom (UK) healthcare system to understand the impact of early versus late diagnosis of COPD.

Patients and Methods

Newly diagnosed COPD patients were identified in the UK Clinical Practice Research Database from 2011 to 2014. Patients whose 5-year medical data before diagnosis revealed ≥3 counts of eight indicators of early COPD were deemed as late-diagnosed, whereas others were deemed as early-diagnosed. We assessed patients’ characteristics; time-to-first, risk, and rates of exacerbation; and healthcare resource utilization (COPD-related clinic visits, Accident and Emergency visits, and hospitalizations) in late- versus early-diagnosed patients.

Results

Of 10,158 patients included in the study, 6783 (67%) were identified as late-diagnosed and 3375 (33%) as early-diagnosed. The median time-to-first exacerbation was shorter in late-diagnosed (14.5 months) versus early-diagnosed (29.0 months) patients, with a significant risk of exacerbation (hazard ratio 1.46 [95% confidence interval: 1.38–1.55]). Additionally, the exacerbation rate (per 100 person-years) over 3 years was higher in late (108.9) versus early (57.2) diagnosed patients. Late-diagnosed patients had a significantly higher rate of COPD hospitalizations (per 1000 patient years) compared with early-diagnosed patients during 2 and 3 years of follow-ups (P = 0.0165 and P < 0.0001, respectively).

Conclusion

Results showed that a significant percentage of COPD patients in UK primary care are diagnosed late. A late COPD diagnosis is associated with a shorter time-to-first exacerbation and a higher rate and risk of exacerbations compared with early diagnosis. Additionally, late diagnosis of COPD is associated with a higher rate of COPD-related hospitalizations compared with early diagnosis.

Keywords:

• chronic obstructive pulmonary disease
• COPD
• clinical practice research datalink
• UK-CPRD
• early diagnosis of COPD
• late diagnosis of COPD
• healthcare utilization

View correction statement:

Clinical Impact and Healthcare Resource Utilization Associated with Early versus Late COPD Diagnosis in Patients from UK CPRD Database [Corrigendum]

Acknowledgments

Editorial and writing support was provided by Santanu Bhadra and Harneet Kaur (Novartis), funded by Novartis AG, Basel, Switzerland, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3). Data analysis was conducted by Pharmatelligence.

Abbreviations

A&E, accident and emergency; BMI, body mass index; CCI, Charlson Comorbidity Index; COPD, chronic obstructive pulmonary disease; CPRD, Clinical Practice Research Datalink; GOLD, Global Initiative for Chronic Obstructive Lung Disease; HES, Hospital Episode Statistics; HCRU, healthcare resource utilization; ICD-10, International Classification of Diseases 10th Revision; ICS, inhaled corticosteroids; ISAC, Independent Scientific Advisory Committee; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; OCS, oral corticosteroid; SABA, short-acting β₂-agonist.

Data Sharing Statement

Novartis is committed to sharing with qualified external researchers’ access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided are anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com.

Ethics Approvals

The study protocol was approved by the CPRD, Independent Scientific Advisory Committee for Medicines and Healthcare products Regulatory Agency database research, UK (ISAC 17_213), and the study was conducted in accordance with the principles of the Declaration of Helsinki.

Consent for Publication

All authors approved the final version and provided consent to publish this manuscript.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting the manuscript, revising the manuscript critically, read and approve the final draft of the manuscript for submission, gave final approval of the manuscript version to be published and agreed to be accountable for every step of the work.

Disclosure

RF, AC, HC and FSG are employees and shareholders of Novartis. EL is an employee of Novartis. KK reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Chiesi, grants and personal fees from ELPEN, grants and personal fees from GSK, grants and personal fees from Novartis, grants and personal fees from Menarini, personal fees from Sanofi, grants from NuvoAir, outside the submitted work; and was an employee of Novartis Pharma AG until October 31, 2018. DP reports board membership and consultancy agreements with Amgen, board membership, consultancy agreements, grants and unrestricted funding for investigator-initiated studies, payment for lectures/speaking engagements and payment for travel/accommodation/meeting expenses from AstraZeneca, board membership, consultancy agreements, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd), payment for lectures/speaking engagements and payment for travel/accommodation/meeting expenses from Boehringer Ingelheim, board membership, consultancy agreements, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) and payment for lectures/speaking engagements from Chiesi, board membership and grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Circassia, payment for lectures/speaking engagements from Cipla, consultancy agreements and payment for lectures/speaking engagements from GSK, payment for lectures/speaking engagements from Kyorin, grants and board membership, consultancy agreements, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd), payment for lectures/speaking engagements and payment for travel/accommodation/meeting expenses from Mylan, board membership, consultancy agreements, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd), payment for lectures/speaking engagements, payment for the development of educational materials and payment for travel/accommodation/meeting expenses from Mundipharma, board membership, consultancy agreements, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd), payment for lectures/speaking engagements, payment for the development of educational materials, payment for travel/accommodation/meeting expenses and funding for patient enrolment and completion of research from Novartis, consultancy agreements and grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Pfizer, board membership, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) and payment for lectures/speaking engagements from Regeneron Pharmaceuticals, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Respiratory Effectiveness Group, board membership, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) and payment for lectures/speaking engagements from Sanofi Genzyme, board membership, consultancy agreements, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd), payment for lectures/speaking engagements from Teva, consultancy agreements and grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Theravance, grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from UK National Health Service, non-financial support from Efficacy and Mechanism Evaluation programme, non-financial support from Health Technology Assessment, outside the submitted work; and stock/stock options from AKL Research and Development Ltd. which produces phytopharmaceuticals; and owns 74% of the social enterprise Optimum Patient Care Ltd. (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd. (Singapore). He also reports personal fees from ThermoFisher. RJ reports grants, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees from Chiesi, grants, personal fees and non-financial support from GSK, non-financial support from Novartis, non-financial support from Nutricia, personal fees and non-financial support from Observational and Pragmatic Research Institute Pte Ltd, personal fees from Pfizer, outside the submitted work. BJ is an employee of Pharmatelligence who received funding from Novartis to conduct analyses for this study. The authors report no other conflicts of interest in this work.