DESCRIPTIVE REAL-WORLD PAYER COMPARISONS OF EXACERBATION FREQUENCY AND HEALTHCARE RESOURCE UTILIZATION AFTER COPD DIAGNOSIS

Abstract

SESSION TITLE: Phenotyping and Management of COPD SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Patients with Chronic Obstructive Pulmonary Disease (COPD) who experience exacerbations present a resource burden on the healthcare system. There is little information on healthcare resource utilization (HRU) across commercial and government payers, providing an opportunity for greater understanding of needs. This study describes COPD-related HRU after first diagnosis in claims data by exacerbation frequency and payer type. METHODS: This retrospective study used Medicare Fee-for-Service (FFS) claims and the Inovalon MORE2 Registry® of commercial (COM), Managed Medicaid (MM), and Medicare Advantage (MA) claims. Patients were aged ≥40 years with continuous enrollment 1 year pre- and post-index. Index date was first emergency department (ED) visit or hospitalization, or first of two outpatient medical visits ≥ 30 days apart between 1/1/2015-9/30/2018 (MORE2) or 1/1/2015-12/31/2017 (FFS) with a COPD diagnosis code. Exclusion criteria were pre-index diagnosis of COPD or use of COPD-related medications, or diagnoses of asthma, cancer, interstitial fibrosis, pulmonary embolism, pulmonary hypertension, or sarcoidosis. Post-index exacerbation events were categorized (0, 1, or 2+) and defined by primary COPD-related diagnosis during inpatient or a COPD-related outpatient/ED visit with a prescription for an antibiotic or oral corticosteroid within 5 days. RESULTS: Among 1,406,727 COPD patients, mean (SD) age was 69.9 (11.6) years, 59.2% were female, and payer distribution was 3.9% MA, 4.5% COM, 7.5% MM, and 84.1% FFS. Post-index, 34.7% experienced ≥1 exacerbation (1=28.8%, 2+=5.9%). The proportion of patients with 2+ exacerbations was consistent across payers: 5.2% MA, 5.5% COM, 5.9% FFS, and 6.0% MM. Overall, 11.6% of patients had ≥1 COPD-related hospitalization and of those 25.3% had a COPD-related 30-day readmission. COPD-related hospitalizations ranged from 9.7% for COM to 18.0% for MA, and 30-day readmission rates from 16.6% for COM to 26.5% for FFS. As the number of exacerbations increased, there were corresponding increases in patients with ≥1 COPD-related ED visits (0=11.5%, 1=23.2%, 2+=34.9%), ≥1 hospitalizations (1=9.2%, 2+=23.7%), and ≥1 30-day readmissions (1=20.5%, 2+=34.4%). For those with 2+ exacerbations, COPD-related ED visit frequency ranged from 34.3% for FFS to 46.0% for MA, and 30-day readmissions from 17.2% for COM to 36.6% for FFS. CONCLUSIONS: Patients experiencing 1 or more exacerbations in the year following COPD diagnosis have high HRU related to hospitalizations, readmissions, and ED visits. The pattern of increasing HRU with greater exacerbation frequency was consistent across payers. CLINICAL IMPLICATIONS: These results highlight a need to evaluate COPD patients early in their disease course for appropriate treatment with the aim of reducing exacerbations, which are directly linked to hospitalizations and readmissions. DISCLOSURES: Employee relationship with Avalere Please note: >$100000 Added 05/28/2020 by Jill Dreyfus, source=Web Response, value=Salary Employee relationship with AstraZeneca Pharmaceuticals LP Please note: >$100000 Added 06/01/2020 by Norbert Feigler, source=Web Response, value=Salary Removed 06/01/2020 by Norbert Feigler, source=Web Response Employee relationship with AstraZeneca Pharmaceuticals LP Please note: >$100000 Added 06/01/2020 by Norbert Feigler, source=Web Response, value=Salary Advisory Committee Member relationship with Astra Zeneca Please note: $1001 - $5000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel DSMB relationship with Spiration Please note: $1001 - $5000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel Advisory Committee Member relationship with GlaxoSmithKline Please note: $1001 - $5000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel Advisory Committee Member relationship with Sunovion Please note: $1001 - $5000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel PI relationship with Pearl Please note: $5001 - $20000 Added 04/29/2020 by Barry Make, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with Circsssia Please note: $1-$1000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel Advisory Committee Member relationship with Third Pole Please note: $1-$1000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel Advisory Committee Member relationship with Shire Please note: $1-$1000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel Advisory Committee Member relationship with Phillips Please note: $1-$1000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel PI relationship with NHLBI Please note: >$100000 Added 04/29/2020 by Barry Make, source=Web Response, value=Grant/Research Support DSMB relationship with Takeda Please note: $1-$1000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel Advisory Committee Member relationship with Wolters Kluwer Health Please note: $1-$1000 Added 04/29/2020 by Barry Make, source=Web Response, value=Travel Removed 04/29/2020 by Barry Make, source=Web Response No relevant relationships by Chad Moretz, source=Web Response No relevant relationships by Alexis Parente, source=Web Response Employee relationship with AstraZeneca Please note: >$100000 Added 06/01/2020 by Michael Pollack, source=Web Response, value=Salary No relevant relationships by Dakota Powell, source=Web Response No relevant relationships by Scott Robinson, source=Web Response No relevant relationships by Ann Xi, source=Web Response