Medical costs of Alpha-1 antitrypsin deficiency-associated COPD in the United States

Jan Sieluk,Eleanor Perfetto,Julia F. Slejko,Henry Silverman,C. Daniel Mullins

doi:10.1186/s13023-020-01523-4

Abstract

BackgroundThere are limited data on economic aspects of the genetic variant of chronic obstructive pulmonary disease (COPD) in the context of the more prevalent form of COPD. The objective of this study was to isolate the healthcare resource utilization and economic burden attributable to the presence of a genetic factor among COPD patients with and without Alpha-1 Antitrypsin Deficiency (AATD), twelve months before and after their initial COPD diagnosis.MethodsRetrospective analysis of OptumLabs® Data Warehouse claims (OLDW; 2000–2017). The OLDW is a comprehensive, longitudinal real-world data asset with de-identified lives across claims and clinical information. AATD-associated COPD cases were matched with up to 10 unique non-AATD-associated COPD controls. Healthcare resource use and costs were assigned into the following categories: office (OV), outpatient (OP), and emergency room visits (ER), inpatients stays (IP), prescription drugs (RX), and other services (OTH). A generalized linear model was used to estimate total pre- and post-index (initial COPD diagnosis) costs from a third-party payer’s perspective (2018 USD) controlling for confounders. Healthcare resource utilization was estimated using a negative binomial regression.ResultsThe study population consisted of 8881 patients (953 cases matched with 7928 controls). The AATD-associated COPD cohort had higher expenditures and use of office visits (OV) and other (OTH) services, as well as OV, outpatient (OP), emergency room (ER), and prescription drugs (RX) before and after the index date, respectively. Adjusted total all-healthcare cost ratios for AATD-associated COPD patients as compared to controls were 2.04 [95% CI: 1.60–2.59] and 1.98 [95% CI: 1.55–2.52] while the incremental cost difference totaled $6861 [95% CI: $3025 - $10,698] and $5772 [95% CI: $1940 - $9604] per patient before and after the index date, respectively.ConclusionsTwelve months before and after their initial COPD diagnosis, patients with AATD incur higher healthcare utilization costs that are double the cost of similar COPD patients without AATD. This study also suggests that increased costs of AATD-associated COPD are not solely attributable to augmentation therapy use. Future studies should further explore the relationship between augmentation therapy, healthcare resource use, and other AATD-associated COPD expenditures.

Highlights

There are limited data on economic aspects of the genetic variant of chronic obstructive pulmonary disease (COPD) in the context of the more prevalent form of COPD
This study suggests that increased costs of Alpha-1 Antitrypsin Deficiency (AATD)-associated COPD are not solely attributable to augmentation therapy use
Future studies should further explore the relationship between augmentation therapy, healthcare resource use, and other AATD-associated COPD expenditures

Summary

Introduction

There are limited data on economic aspects of the genetic variant of chronic obstructive pulmonary disease (COPD) in the context of the more prevalent form of COPD. Patients with HER2-positive breast cancer are managed differently as compared to women with triple-negative disease [2, 3]; patients with MYH-associated polyposis require thorough medical scrutiny due to an almost 100% risk of developing colorectal cancer before reaching the age of 65 [4, 5]; patients with Alpha-1 Antitrypsin Deficiency who developed chronic obstructive pulmonary disease (AATD-associated COPD) may need augmentation therapy, not indicated for COPD patients with normal serum levels of Alpha-1 Antitrypsin protein (AAT) [6,7,8,9,10,11,12,13,14]. Given the significant morbidity and mortality of COPD in the United States and worldwide, coupled with an increasing recognition and economic burden of the disease, it is surprising how little is known in terms of the contemporary direct medical costs of AATD-associated COPD [6, 15,16,17,18,19,20]. AATD is associated with the development of an early emphysema and chronic bronchitis, which may be collectively described as COPD; less frequently associated with cirrhosis (in patients over 50 years of age and among infants – fulminant neonatal hepatic syndrome), hepatocellular carcinoma, vasculitis and rarely skin diseases like necrotizing panniculitis [21, 24,25,26,27]

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