Real-World Treatment of Patients Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective German Claims Data Analysis

Figures & data

Figure 1 Attrition chart of patient selection.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 1 Characteristics of the Identified Incident COPD Patients

	All Incident COPD Patients	Incident Patients with 12-Month FU^a	Incident Patients with 36-Month FU^b
N	17,464	14,213	3,804
Observed total PY (FU)	34,648	14,213	11,412
Sex, female
N (%)	7,170 (41.1%)	5,855 (41.2%)	1,565 (41.1%)
Age, at index date
Mean (SD)	71.5 (12.3)	70.1 (12.1)	68.6 (11.8)
Median (Range)	73 (40–105)	71 (40–100)	69 (40–97)
CCI^c
Mean (SD)	5.3 (3.2)	4.8 (3.0)	4.3 (2.7)
Median (Range)	5 (1–21)	4 (1–20)	4 (1–18)
TOP-10 comorbidities, N (%)
Hypertension	14,520 (83.1%)	11,847 (83.4%)	3,155 (82.9%)
Hyperlipidemia	8,802 (50.4%)	7,148 (50.3%)	1,901 (50.0%)
Heart failure	8,588 (49.2%)	6,997 (49.2%)	1,846 (48.5%)
Type 2 diabetes	7,510 (43.0%)	6,133 (43.2%)	1,631 (42.9%)
Coronary artery disease	7,132 (40.8%)	5,800 (40.8%)	1,573 (41.3%)
Back pain	6,965 (39.9%)	5,667 (39.9%)	1,497 (39.3%)
Dyspnea	6,403 (36.7%)	5,178 (36.4%)	1,394 (36.6%)
Chronic kidney diseases	6,031 (34.5%)	4,887 (34.4%)	1,264 (33.2%)
Hypertensive heart disease	5,782 (33.1%)	4,687 (33.0%)	1,207 (31.7%)
Respiratory failure^d	5,741 (32.9%)	4,661 (32.8%)	1,239 (32.6%)
Medication history, N (%)
Beta-blocking agents	8,196 (46.9%)	6,612 (46.5%)	1,761 (46.3%)
Proton pump inhibitors	7,476 (42.8%)	6,015 (42.3%)	1,599 (42.0%)
Sulfonamide diuretics	6,793 (38.9%)	5,465 (38.5%)	1,411 (37.1%)
Statins	5,848 (33.5%)	4,671 (32.9%)	1,236 (32.5%)
ACE inhibitors	5,412 (31.0%)	4,371 (30.8%)	1,191 (31.3%)
Initial Dx observed during an inpatient stay, N (%)	13,660 (78.2%)	10,542 (74.2%)	2,589 (68.1%)
Disease severity
COPD with FEV1 <35%	1,171 (6.7%)	926 (6.5%)	240 (6.3%)
COPD with FEV1 35–50%	1,490 (8.5%)	1,227 (8.6%)	315 (8.3%)
COPD with FEV1 50–70%	2,813 (16.1%)	2,439 (17.2%)	731 (19.2%)
COPD with FEV1 >70%	1,952 (11.2%)	1,757 (12.4%)	513 (13.5%)
FEV1 not specified	10,038 (57.5%)	7,864 (55.3%)	2,005 (52.7%)

Notes: ^aSubsample of all incident COPD patients: Exclusion of patients with index date after 31/03/2018 and of patients who died within the first 12 months after incident COPD diagnosis. ^bSubsample of all incident COPD patients: Exclusion of patients with index date after 31/03/2016 and of patients who died within the first 36 months after incident COPD diagnosis. ^cIndex was assessed based on diagnoses observed in the 12-month pre-index period and was calculated without consideration of age component. ^dPreviously unspecified respiratory failure was identified via ICD-10 code J96.

Abbreviations: ACE, angiotensin-converting enzyme; CCI, Charlson Comorbidity Index; COPD, chronic obstructive pulmonary disease; Dx, diagnosis; FEV₁, forced expiratory volume in 1 second; FU, follow-up; N, number; PY, patient-years; SD, standard deviation.

Figure 2 Kaplan-Meier curves depicting the time to treatment initiation after incident COPD diagnosis.

Note: Censoring events: death or end of follow-up (31/03/2019).

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; ICS, Inhaled glucocorticosteroids; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.

Figure 3 Frequency of inhaled maintenance therapies per line of treatment.

Notes: Only based on patients receiving either long-acting bronchodilators or ICS; a combination treatment was assumed if the respective agents were prescribed within a 60-days window and a similar prescription behavior was repeated at least once.

Abbreviations: ICS, inhaled glucocorticosteroids; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.

Figure 4 Treatment cascades observed after incident COPD diagnosis in a sample of patients with a follow-up of 36 months (n=3,804).

Notes: Other treatments include use of LABA alone, ICS alone, roflumilast and methylxanthines (alone or in combination with other therapies).

Abbreviations: ICS, inhaled glucocorticosteroids; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.

Figure 5 Kaplan-Meier curve depicting the time to first severe exacerbation (hospitalization with main diagnosis ICD-10GM code J44.1) after incident COPD diagnosis.

Note: Censoring events: death or end of follow-up (31/03/2019).

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease.

Figure 6 COPD-related direct healthcare cost per patient-year.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease.