Early Detection Programs May Help Offset Costs of COPD Exacerbations, Studies Find

Exacerbations of patients with chronic obstructive pulmonary disorder (COPD) can be costly if they are frequent, and early detection programs for COPD may help offset these costs, according to research from 2 studies presented at the 2020 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) virtual conference.

Investigators from the University of Maryland School of Pharmacy conducted a retrospective cohort study¹ of patients with COPD to characterize resource use and cost burdens for patients with frequent exacerbations. According to authors, COPD exacerbations are associated with excessive health care resource utilization and costs. Researchers then compared data with patients with COPD who experience infrequent exacerbations.

The nationally representative sample included adults aged 65 or older with COPD and 12 months of continuous enrollment in Medicare Parts A, B, and D. The study authors defined frequent exacerbations as 2 or more hospitalizations or emergency room visits within 12 months.

In total, 92,318 eligible beneficiaries were included in the study, of which 3,338 experienced frequent exacerbations. Both groups with and without frequent exacerbations were 58% female, 87% white, and aged 76 and 78 years, respectively.

Incidence rates for COPD-related hospitalization and outpatient visits were 161 and 410, respectively, per 100 person-years for those with frequent exacerbations. Rates for all-cause visits were 184 and 1,078, respectively, in the frequent exacerbation cohort.

Authors determined that COPD-related and all-cause rates for hospitalization and outpatient visits observed in those without frequent exacerbations were 44 and 74, respectively.

In addition, mean annual health services cost was $31,421 for beneficiaries with frequent exacerbations and $19,207 for patients without frequent exacerbations, researchers found. The mean cost for COPD-related services was $21,203 for those with frequent exacerbations and $7,170 for those without.

Each frequent exacerbation patient spent an average of $2,635 annually on COPD medications. In comparison, those without frequent exacerbations spent $1,277 annually on COPD medications.

“Older COPD patients experience excessive clinical and economic burdens,” researhcers concluded. “Frequent exacerbations are associated with substantially higher service utilization and costs compared to those without frequent exacerbations. Optimal disease management will benefit all COPD patients, especially those suffering multiple COPD exacerbations.”

In an additional study², investigators from the University of Washington in Seattle and the University of British Columbia in Vancouver assessed cost-effectiveness of various primary care-based case detection strategies for COPD. Data were compiled from a previously existing study, in which eligible patients received a COPD Diagnostic Questionnaire at 3- or 5-year intervals during routine visits to a primary care physician.

Newly diagnosed patients received treatment for smoking cessation as well as guideline-based inhaler pharmacotherapy, authors explained.

Incremental cost effectiveness ratios (ICERs) were measured. In 16 case detection scenarios, researchers found ICER was below a $50,000/quality-adjusted life year (QALY) willingness to pay threshold compared with no case detection. Costs were reported in 2015 Canadian dollars.

Investigators found the most efficient scenario occurred when all patients over the age of 40 received the COPD questionnaire at 3-year intervals, which was associated with an incremental cost of $180 per eligible patient. This also resulted in an incremental effectiveness of 0.009 QALYs per eligible patient and an ICER of $21,108/QALY compared with patients who received the COPD questionnaire at 5-year intervals.

The 5-year interval questionnaire was the second-most effective scenario, according to investigators. “Primary care-based case detection programs for COPD are likely to be cost-effective if adherence to best-practice recommendations for treatment is high,” authors concluded.

References:

1. Le T, Fleming S, Aynalem A, et al. Healthcare resource utilization and costs in older COPD patients with and without frequent exacerbations. Presented at: ISPOR 2020; May 18-20, 2020; Abstract PRS1
2. Johnson K, Sadatsafavi M, Adibi A, et al. Cost-effectiveness of case detection strategies for the early detection of COPD. Presented at: ISPOR 2020; May 18-20, 2020; Abstract PRS17.