VARIATIONS HIGHLIGHTED IN HYPERLOCAL HEATMAPS CAN ADDRESS UNMET NEED AND ALLOCATION OF RESOURCES IN COPD

Abstract

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Population data for chronic obstructive pulmonary disease (COPD) prevalence and morbidity in the US are available primarily through state-level surveys. Acquisition of regional (or subnational) data on unstable COPD (uCOPD; i.e., ≥ 2 annual steroid-treated exacerbations) is possible through secondary use of national claims datasets. We sought to define the prevalence of uCOPD by examining state- and county-level morbidity in large medication claims datasets, thereby reducing the inaccuracies associated with survey model-based approaches. METHODS: COPD and uCOPD were identified using medical and pharmacy claims from the IQVIA Longitudinal Access and Adjudication Data database for US patients from all payer groups from 2017 to 2019. Patients with a COPD claim who were <40 years of age, had <1 annual maintenance or rescue inhaler prescription, had other respiratory disorders, or had other chronic diseases that use corticosteroids were excluded. Heatmaps were generated to summarize the relative ranking of all 50 states and 3143 counties based on the number and percentage of uCOPD patients. States and counties were divided into quartiles according to the range of patients with uCOPD (eg, in states classified as Quartile 1, the number of uCOPD patients fell within the bottom quarter of the range of uCOPD patients across all 50 states). Quartiles 1 and 4 referred to the fewest and greatest number of patients with uCOPD, respectively. RESULTS: Of 13.1 million individuals with a COPD claim in 2019, 3.1 million met selection criteria for COPD and 0.8 million (~26%) met selection criteria for uCOPD. The percentage of patients with uCOPD was 28.4% in 2017, 28.4% in 2018, and 26.8% in 2019. During this period, patients with COPD received an average of 2 systemic corticosteroid, 4.2 rescue inhaler, and 4.7 maintenance prescriptions annually. In 2019, the 13 states in Quartile 4 accounted for 60.1% of all uCOPD patients, and the 767 counties (from all 50 states, predominantly in Midwest, Southeast, and Mid-Atlantic regions) in Quartile 4 accounted for 74.1% of all uCOPD patients. The percentage of patients with uCOPD declined between 2017 and 2019 by 0.9%, 1.0%, 1.4%, and 1.7% in Quartiles 1-4, respectively. Within Quartile 4, 598 counties showed a decline of 2.4% in patients with uCOPD and 141 showed an increase of 1.2%. CONCLUSIONS: State- and county-level heatmaps using data from a large administrative and medication claims database reveal that although year-to-year fluctuations occur, overall there is an imbalance in the distribution of patients with uCOPD and/or standard of care across different states and counties, with high burden counties in states with overall low prevalence. CLINICAL IMPLICATIONS: Hyperlocal COPD data can help optimize allocation of resources to address localized unmet need in COPD. Long term sustained improvements in the rate of uCOPD can only be accomplished through local insights. DISCLOSURES: Consultant relationship with AstraZeneca Please note: >$100000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Genentech Please note: $20001 - $100000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Genzyme Corporation Please note: $5001 - $20000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Novartis Please note: $5001 - $20000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Circassia Please note: $1001 - $5000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with GlaxoSmithKline Please note: $1-$1000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Employee relationship with AstraZeneca Pharmaceuticals LP Please note: >$100000 Added 04/16/2021 by Norbert Feigler, source=Web Response, value=Salary Employee relationship with Astrazeneca Please note: >$100000 by Hitesh Gandhi, source=Web Response, value=Salary My spouse/partner as a Employee relationship with Pfizer Please note: >$100000 by Hitesh Gandhi, source=Web Response, value=Salary