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

Figures & data

Figure 1 Study design.

Abbreviations: EOS, eosinophil count; ICS, inhaled corticosteroid.

Figure 2 Eligibility criteria. EMR patient cohort (n=48,090) linked to claims (n=39,939).

Abbreviations: COPD, chronic obstructive pulmonary disease; EMR, electronic medical record.

Table 1 Eosinophil Levels: Index^a, Baseline, And Follow-Up

Time Period	Index Eosinophil Group
	All	<220 cells/μL	≥ 220 cells/μL	≥ 300 cells/μL	≥ 400 cells/μL
	(n=48,090)	(n=27,211)	(n=20,879)	(n=16,737)	(n=8,946)
EMR Patients^b
Index
N	48,090	27,211	20,879	16,737	8,946
Mean (SD)	252.2 (172.1)	138.9 (58.1)	399.8 (159.2)	435.6 (158.2)	538.8 (152.6)
Baseline
N	19,178	8,870	10,308	8,296	4,673
Mean (SD)	229.4 (162.3)	129.5 (64.5)	333.9 (168.0)	361.4 (173.2)	434.0 (190.2)
Follow-up
N	25,473	13,139	12,334	10,075	5,522
Mean (SD)	200.1 (141.5)	121.3 (74.2)	273.2 (149.5)	291.3 (153.9)	343.0 (168.6)
Integrated Patients^c
Index
N	39,939	22,542	17,397	13,913	7,440
Mean (SD)	252.3 (171.8)	139.0 (58.1)	399.2 (158.6)	435.2 (157.6)	538.0 (151.9)
Baseline
N	15,871	7,348	8,523	6,854	3,855
Mean (SD)	222.0 (156.0)	122.5 (67.2)	296.1 (161.9)	318.5 (167.6)	377.0 (184.1)
Follow-up
N	21,047	10,820	10,227	8,332	4,572
Mean (SD)	218.5 (154.4)	125.1 (68.6)	300.8 (162.0)	322.7 (167.2)	382.6 (184.2)

Notes: ^aIndex eosinophil level was required; ^bpatients with data from the EMR data source; ^cpatients with data from both the EMR data source and the claims data source.

Table 2 Baseline Demographic & Clinical Characteristics

Variable	Index Eosinophil Group
	All	<220 cells/μL	≥ 220 cells/μL	≥ 300 cells/μL	≥ 400 cells/μL
	(n= 39,939)	(n= 22,542)	(n= 17,397)	(n= 13,913)	(n= 7,440)
Age, Mean (SD)	67.2 (11.4)	66.5 (11.5)	68.1 (11.2)	68.2 (11.2)	68.5 (11.2)
BMI, Mean (SD)	29.8 (7.6)	29.5 (7.6)	30.1 (7.6)	30.1 (7.6)	30.0 (7.4)
Sex (Female)	23,271 (58.3)	13,968 (62.0)	9,303 (53.5)	7,342 (52.8)	3,719 (50.0)
Smoking Status
Current	11,909 (29.8)	6,943 (30.8)	4,966 (28.5)	3,989 (28.7)	2,044 (27.5)
Former	16,646 (41.7)	9,039 (40.1)	7,607 (43.7)	6,117 (44.0)	3,346 (45.0)
Never	8,636 (21.6)	5,010 (22.2)	3,626 (20.8)	2,868 (20.6)	1,553 (20.9)
Unknown	376 (0.9)	225 (1.0)	151 (0.9)	108 (0.8)	58 (0.8)
Not Reported	2,372 (5.9)	1,325 (5.9)	1,047 (6.0)	831 (6.0)	439 (5.9)
Charlson Comorbidity Index^a
Mean (SD)	2.6 (1.9)	2.5 (1.8)	2.8 (2.0)	2.8 (2.0)	2.9 (2.0)
Diagnosis Count^b
1	14,143 (35.4)	8,715 (38.7)	5,428 (31.2)	4,263 (30.6)	2,183 (29.3)
2–3	15,733 (39.4)	8,859 (39.3)	6,874 (39.5)	5,528 (39.7)	2,901 (39.0)
4+	10,061 (25.2)	4,968 (22.0)	5,093 (29.3)	4,120 (29.6)	2,354 (31.6)
Diagnosis
Anxiety	11,688 (29.3)	6,808 (30.2)	4,880 (28.1)	3,875 (27.9)	2,022 (27.2)
Asthma	7,227 (18.1)	3,855 (17.1)	3,372 (19.4)	2,754 (19.8)	1,581 (21.3)
Depression	10,289 (25.8)	5,799 (25.7)	4,490 (25.8)	3,618 (26.0)	1,902 (25.6)
Physician Visits, mean (SD)	8.4 (7.4)	8.2 (7.1)	8.6 (7.8)	8.6 (7.9)	8.8 (8.3)
Corticosteroid Use (1+ Rx)
ICS use	6,933 (17.4)	3,649 (16.2)	3,284 (18.9)	2,685 (19.3)	1,542 (20.7)
SCS use	779 (2.0)	446 (2.0)	333 (1.9)	276 (2.0)	151 (2.0)
Mod. to Sev. Exacerbation (1+)	2,858 (7.2)	1,487 (6.6)	1,371 (7.9)	1,094 (7.9)	635 (8.5)
Baseline COPD Costs, mean (SD)	$3,671 ($19.5k)	$3,263 ($16.6k)	$4,199 ($22.7k)	$4,311 ($24.0k)	$4,634 ($27.3k)

Notes: Data are reported as n (%) unless otherwise specified. ^aThe Quan Enhanced Comorbidity score ranges from 0 to 37; ^bcount of co-morbid conditions included in Quan Enhanced Comorbidity score.

Abbreviations: ICS, inhaled corticosteroid; SCS, systemic corticosteroid.

Table 3 Clinical Outcomes

COPD-Related Outcome	Index Eosinophil Group
	<220 cells/μL	≥ 220 cells/μL	≥ 300 cells/μL	≥ 400 cells/μL
	(n=22,542)	(n=17,397)	(n=13,913)	(n=7,440)
Moderate Exacerbation
Patients	1,370 (6.1%)	1,177 (6.8%)†	950 (6.8%)†	536 (7.2%)†
Events (total)	2,111	1,820	1,474	836
Events^a (per patient^b)	0.094	0.105†	0.106†	0.112†
Severe Exacerbation
Patients	554 (2.5%)	541 (3.1%)^ǂ	439 (3.2%)^ǂ	256 (3.4%)^ǂ
Events (total)	675	669	556	329
Events (per patient)	0.03	0.038^ǂ	0.04^ǂ	0.044^ǂ
ICS Treatment (Follow-Up)
No	16,763 (74.4%)	12,202 (70.1%)^ǂ	9,680 (69.6%)^ǂ	5,048 (67.8%)^ǂ
Yes, new in follow-up	2,130 (9.4%)	1,911 (11.0%)^ǂ	1,548 (11.1%)^ǂ	850 (11.4%)^ǂ

Notes: Statistical significance is indicated as ^ǂp <0.001; †p<0.05 (<220 vs ≥ 220, ≥ 300, ≥ 400 cells/μL). ^avalues are mean unless otherwise specified; ^bevents per patient is the rate of events per patient for all patient in the category.

Table 4 Healthcare Resource Use – All-Cause

COPD-Related Outcome	Index Eosinophil Group
	<220 cells/μL	≥ 220 cells/μL	≥ 300 cells/μL	≥ 400 cells/μL
	(n=22,542)	(n=17,397)	(n=13,913)	(n=7,440)
Inpatient Hospitalizations
Patients	1,405 (6.2%)	1,260 (7.2%)^ǂ	1,017 (7.3%)^ǂ	577 (7.8%)^ǂ
Events (total)	2,490	2,412	1,935	1,061
Events^a (per patient^b)	0.110 (0.5)	0.139 (0.7)^ǂ	0.139 (0.7)^ǂ	0.143 (0.7)^ǂ
ED Visits
Patients	3,626 (16.1%)	2,768 (15.9%)	2,245 (16.1%)	1,206 (16.2%)
Events (total)	9,064	6,644	5,392	2,926
Events (per patient)	0.402 (1.4)	0.382 (1.5)	0.388 (1.5)	0.393 (1.4)
Outpatient Office Visits/Procedures
Patients	17,770 (78.8%)	13,938 (80.1%)†	11,183 (80.4%)^ǂ	6,013 (80.8%)^ǂ
Events (total)	860,898	710,083	571,186	316,259
Events (per patient)	38.2 (65.8)	40.8 (72.1)^ǂ	41.1 (73.5)^ǂ	42.5 (78.0)^ǂ
Pharmacy Use
Patients	21,598 (95.8%)	16,687 (95.9%)	13,354 (96.0%)	7,146 (96.0%)
Events (total)	924,360	754,155	609,914	328,540
Events (per patient)	41 (39.5)	43.3 (40.0)^ǂ	43.8 (39.8)^ǂ	44.2 (40.0)^ǂ

Notes: Statistical significance is indicated as ^ǂp <0.001; †p<0.05 (<220 vs ≥ 220, ≥ 300, ≥ 400 cells/μL). ^avalues are mean (SD) unless otherwise specified; ^bevents per patient is the rate of events per patient for all patient in the category.

Table 5 Healthcare Resource Use – COPD-Related

COPD-Related Outcome	Index Eosinophil Group
	<220 cells/μL	≥ 220 cells/μL	≥ 300 cells/μL	≥ 400 cells/μL
	(n=22,542)	(n=17,397)	(n=13,913)	(n=7,440)
Inpatient Hospitalizations
Patients	671 (3.0%)	658 (3.8%)^ǂ	531 (3.8%)^ǂ	298 (4.0%)^ǂ
Events (total)	1,094	1,137	916	513
Events^a (per patient^b)	0.049 (0.3)	0.065 (0.4)^ǂ	0.066 (0.5)^ǂ	0.069 (0.5)^ǂ
ED Visits
Patients	827 (3.7%)	693 (4.0%)	557 (4.0%)	318 (4.3%)†
Events (total)	1,480	1,251	1,010	632
Events (per patient)	0.066 (0.5)	0.072 (0.6)	0.073 (0.6)	0.085 (0.7)†
Outpatient Office Visits/Procedures
Patients	6,435 (28.5%)	5,429 (31.2%)^ǂ	4,372 (31.4%)^ǂ	2,410 (32.4%)^ǂ
Events (total)	110,336	98,255	79,554	45,415
Events (per patient)	4.9 (16.3)	5.6 (21.3)^ǂ	5.7 (22.1)^ǂ	6.1 (25.2)^ǂ
Pharmacy Use
Patients	17,287 (76.7%)	13,697 (78.7%)^ǂ	11,003 (79.1%)^ǂ	5,917 (79.5%)^ǂ
Events (total)	137,775	116,637	95,414	53,838
Events (Per patient)	6.1 (8.9)	6.7 (9.1)^ǂ	6.9 (9.3)^ǂ	7.2 (9.7)^ǂ

Notes: Statistical significance is indicated as ^ǂp <0.001; †p<0.05 (<220 vs ≥ 220, ≥ 300, ≥ 400 cells/μL). ^avalues are mean (SD) unless otherwise specified; ^bevents per patient is the rate of events per patient for all patient in the category.

Table 6 Healthcare Cost – All-Cause & COPD-Related Cost (Per Patient)

COPD-Related Outcome	Index Eosinophil Group
	<220 cells/μL	≥ 220 cells/μL	≥ 300 cells/μL	≥ 400 cells/μL
	(n=22,542)	(n=17,397)	(n=13,913)	(n=7,440)
All-Cause Cost
Overall^a	$21,049 (59,014)	$24,670 (72,026)^ǂ	$24,935 (72,169)^ǂ	$26,199 (80,476)^ǂ
Hospitalization/inpatient	$4,837 (31,999)	$6,524 (44,676)^ǂ	$6,457 (42,300)^ǂ	$7,126 (46,786)^ǂ
ED visits	$427 (1,649)	$445 (1,918)	$446 (1,841)	$466 (1,929)
Outpatient visits/procedures	$10,282 (37,190)	$11,908 (47,094)^ǂ	$12,141 (50,096)^ǂ	$12,876 (56,685)^ǂ
Pharmacy	$5,503 (20,760)	$5,793 (12,365)	$5,891 (12,430)†	$5,731 (10,010)
COPD-Related Cost
Overall	$4,357 (22,884)	$5,407 (28,402)^ǂ	$5,491 (28,974)^ǂ	$5,774 (31,376)^ǂ
Hospitalization/inpatient	$2,065 (19,462)	$2,764 (24,630)†	$2,791 (25,206)†	$3,011 (27,516)†
ED visits	$80 (624)	$95 (906)	$94 (817)	$112 (1,001)†
Outpatient visits/procedures	$1,316 (7,125)	$1,532 (8,367)^ǂ	$1,555 (8,547)^ǂ	$1,548 (7,785)^ǂ
Pharmacy	$896 (2,554)	$1,016 (2,487)^ǂ	$1,051 (2,457)^ǂ	$1,102 (2,524)^ǂ

Notes: Statistical significance is indicated as ^ǂp <0.001; †p<0.05 (<220 vs ≥ 220, ≥ 300, ≥ 400 cells/μL). ^avalues are mean (SD) unless otherwise specified.

Figure 3 Adjusted percent change in COPD-related and all-cause annual healthcare cost for blood eosinophil count as a continuous measure.

Note: Adjusting for age, gender, smoking status, exacerbations, inhaled and systematic corticosteroid (ICS, SCS) treatment, Charlson comorbidity index (CCI), asthma, baseline COPD cost.

Figure 4 Adjusted percent change in COPD-related and all-cause annual healthcare cost for blood eosinophil count as a dichotomous measure, <220 cells/μL ≥220 cells/μL.

Note: Adjusting for age, gender, smoking status, exacerbations, inhaled and systematic corticosteroid (ICS, SCS) treatment, Charlson comorbidity index (CCI), asthma, baseline COPD cost.