Economic and quality of life consequences of clinically important deterioration in patients with COPD: results from the TORCH study

Abstract

Introduction: Clinically important deterioration (CID) in COPD is a measure of meaningful short-term worsening in lung function, health status or a first acute exacerbation. The economic and quality of life (QoL) impact of avoiding CID is unclear. This analysis of data from the 3-year TOwards a Revolution in COPD Health (TORCH) study examined this question. Methods: This post hoc analysis of TORCH (NCT00268216) compared annual costs and QoL in unstable patients with any CID (CID+) vs stable CID-free patients (CID-). CID+ status in any treatment arm in the first 6 months was defined as: ≥100 mL decline in FEV1 or ≥4-unit deterioration in SGRQ total score from baseline or a first moderate/severe exacerbation. Costs were calculated based on healthcare resource use captured from 6 months to study end, applying UK NHS unit costs. QoL was measured using the EQ-5D utility index. Adjusted values, controlled for baseline characteristics, treatment assignment and CID status, are presented. Results: Following study completion, 3769 and 1989 patients contributed to the 3-year cost and QoL analysis, respectively. Significantly lower annual costs/patient and higher utility scores were seen for CID- vs CID+ patients (Figure). Conclusions: Maintaining COPD stability and avoiding short-term CID may be associated with year-on-year cost savings and better preservation of QoL. Funding: GSK (HO-16-16345)