Economic Impact of Low Adherence to COPD Management Guidelines in Spain

Figures & data

Figure 1 Spanish population ≥ 40 years with diagnosed and treated COPD.

Notes: ^aNational data, for the analysis by Autonomous Communities, the population in said region was considered.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2 Distribution of patients considered in each GOLD group and GesEPOC phenotype in the base case analysis (A and B) and scenario analysis 1 (C), based on literature ^a. (A) Distribution of patients according to the GOLD strategy used in the base case analysis.¹⁷ (B). Distribution of patients according to the GesEPOC guide used in the base case analysis.¹⁷ (C). Distribution of patients to each GesEPOC phenotype used in scenario analysis 1.⁹

Notes: ^aThe current treatment prescription patterns only take into account patients treated with the main treatments (LAMA, LABA, LAMA/LABA, LABA/ICS and LAMA/LABA/ICS).

Abbreviations: ACO, asthma-COPD overlap; COPD, chronic obstructive pulmonary disease; GesEPOC, Spanish Guidelines for Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; ICS, inhaled corticosteroids; LABA, long-acting β2 adrenergic agonists; LAMA, long-acting muscarinic antagonists.

Figure 3 Base case analysis: current treatment patterns and proposed treatment according to GOLD (A) and GesEPOC (B) recommendations. (A) Current treatment patterns in pulmonology according to GOLD groups¹⁷ and proposed treatment patterns based on the GOLD strategy.⁵ (B) Current treatment patterns in pulmonology according to GesEPOC phenotypes¹⁷ and proposed treatment patterns based on the recommendations of the GesEPOC guidelines.⁶

Notes: ^aIt was considered that 28.4% of the patients in GOLD groups C and D had eosinophilia >300 cells/µL³¹ assuming that these patients were treated with ICS therapies. It was considered to maintain the treatment to patients with high blood eosinophils and to treat with LAMA/LABA the rest of the patients currently treated with ICS therapies. ^bPatients with inappropriate therapy who can be treated with more than one therapeutic option, have been distributed according to the current treatment shares of the phenotype considered.

Abbreviations: ACO, asthma-COPD overlap; COPD, chronic obstructive pulmonary disease; GesEPOC, Spanish Guidelines for Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; ICS, inhaled corticosteroids; LABA, long-acting β2 adrenergic agonists; LAMA, long-acting muscarinic antagonists; Treat., treatment.

Table 1 Annual Pharmacological Cost Considered by Each Therapeutic Group

Therapeutic Group	Annual Drug Cost per Patient^a,b
LAMA	€490.97
LABA	€426.51
LAMA/LABA	€770.49
LABA/ICS	€527.91
LAMA/LABA/ICS	€952.07

Notes: ^aValues in PPI + VAT, considering the deduction of RDL 8/2010. ^bFor the data on drugs with dual indication (COPD and asthma), it is assumed that 75% of the total sales of LAMA and 64% of the total sales of LABA (with or without ICS) correspond to COPD.³⁵

Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; LABA, long-acting β2 adrenergic agonists; LAMA, long-acting muscarinic antagonists; PPI + VAT, public price including VAT; RDL, royal decree law; VAT, value added tax.

Table 2 COPD Patients Not Adherent to GOLD Recommendations and GesEPOC Guidelines in Pulmonology Units (Base Case Analysis)

Patients (%) Non-Adherent to Recommendations
Strategy	Current Treatment in Clinical Practice
	LAMA	LABA	LAMA/LABA	LABA/ICS	LAMA/LABA/ICS	Total
GOLD
Group A (N = 141,309)	0	0	0	21,326 (15.1%)	44,321 (31.4%)	65,648 (46.5%)
Group B (N = 75,476)	0	0	0	8,716 (11.5%)	40,242 (53.3%)	48,958 (64.9%)
Group C (N = 41,540)	0	556 (1.3%)	0	4,294 (10.3%)	15,435 (37.2%)	20,285 (48.8%)
Group D (N = 106,817)	0	556 (0.5%)	0	7,049 (6.6%)	53,669 (50.2%)	61,274 (57.4%)
Total (N = 365,142)	0	1,113 (0.3%)	0	41,385 (11.3%)	153,667 (42.1%)	196,164 (53.7%)
GesEPOC
Non-exacerbator (N = 213,742)	0	0	0	24,491 (11.5%)	83,864 (39.2%)	108,355 (50.7%)
Exacerbator with emphysema (N = 34,510)	2,041 (5.9%)	186 (0.5%)	0	6,308 (18.3%)	0	8,535 (24.7%)
Exacerbator with chronic bronchitis (N = 87,204)	2,226 (2.6%)	371 (0.4%)	0	8,535 (9.8%)	0	11,132 (12.8%)
ACO (N = 29,686)	742 (2.5%)	928 (3.1%)	2,041 (6.9%)	5,731 (19.3%)	0	9,441 (31.8%)
Total (N = 365,142)	5,010 (1.4%)	1,484 (0.4%)	2,041 (0.6%)	45,065 (12.3%)	83,864 (23.0%)	137,464 (37.6%)

Notes: Lack of adherence to the guidelines: patients who change treatment due to its adequacy according to guideline recommendations.

Abbreviations: ACO, asthma-COPD overlap; COPD, chronic obstructive pulmonary disease; GesEPOC, Spanish Guidelines for Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; ICS, inhaled corticosteroids; LABA, long-acting β2 adrenergic agonists; LAMA, long-acting muscarinic antagonists.

Figure 4 Pharmaceutical expenditure and annual savings in patients treated in exclusively pulmonology services (base case analysis) (A and B) or pulmonology and primary care (scenario analysis 1) (C). (A) Following recommendations of the GOLD strategy (base case). (B) Following recommendations of the GesEPOC guide (base case). (C) Following the recommendations of the GesEPOC guide (scenario analysis 1).

Abbreviations: GesEPOC, Spanish Guidelines for Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; ICS, inhaled corticosteroids; LABA, long-acting β2 adrenergic agonists; LAMA, long-acting muscarinic antagonists.

Figure 5 Base case analysis: annual savings in pharmaceutical expenditure in patients treated in pulmonology services distributed by Autonomous Community according to the GOLD (A) and GesEPOC (B) guidelines^a. (A) Following GOLD strategy recommendations. (B) Following GesEPOC guideline.

Notes: ^aThe sum of the costs of the regions does not correspond to the total Spanish cost (Figure 4) as the pharmacological costs have been weighted according to their sales in each region.

Abbreviations: GesEPOC, Spanish Guidelines for Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease.

Table 3 COPD Patients Treated Without Following GesEPOC Guidelines in Pulmonology and Primary Care Units (Scenario Analysis 1)

Patients (%) Non-Adherent to Recommendations
GesEPOC Phenotype	Current Treatment in Clinical Practice
	LAMA	LABA	LAMA/LABA	LABA/ICS	LAMA/LABA/ICS	Total
Non-exacerbator (N = 167,357)	0	0	0	13,140 (7.9%)	60,857 (36.4%)	73,997 (44.2%)
Exacerbator with emphysema (N = 65,698)	692 (1.1%)	0	0	6,916 (10.5%)	0	7,607 (11.6%)
Exacerbator with chronic bronchitis (N = 105,808)	1,383 (1.3%)	692 (0.7%)	0	5,532 (5.2%)	0	7,607 (7.2%)
ACO (N = 26,279)	1,383 (5.3%)	0	1,383 (5.3%)	4,576 (17.4%)	0	7,343 (27.9%)
Total (N = 365,142)	3,458 (0.9%)	692 (0.2%)	1,383 (0.4%)	30,164 (8.3%)	60,857 (16.7%)	96,554 (26.4%)

Notes: Lack of adherence to guidelines: patients who change treatment due to an adaptation to guideline recommendations.

Abbreviations: ACO, asthma-COPD overlap; COPD, chronic obstructive pulmonary disease; GesEPOC, Spanish Guidelines for Chronic Obstructive Pulmonary Disease; ICS, inhaled corticosteroids; LABA, long-acting β2 adrenergic agonists; LAMA, long-acting muscarinic antagonists.

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