Maintenance Treatment May Reduce Hospitalization in COPD

Chronic obstructive pulmonary disease (COPD) patients who required hospitalization or an emergency department (ED) visit for exacerbations saw significant reductions in COPD-related costs after receiving prompt initiation of maintenance treatment (MT) following hospitalization.

In the United States, it’s estimated that COPD has $75 billion in annual costs for a nationally representative population, and $15.7 billion for commercially insured patients. Direct health care costs account for 39% to 73% of these total costs, with hospitalization being a major part of it.

In fact, patients with COPD exacerbations have 10 times the annual health care costs as patients without exacerbations. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, a central component in managing patients with moderate-to-severe COPD are therapies, such as long-acting β₂-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroids (ICS).

Research has shown that the initiation of MT with these agents was beneficial for these patients, and reduced hospitalization and exacerbations. However, there has only been 1 empirical study to show the importance of MT initiation timing.

In the current study, the primary objective was to compare the impact of prompt versus delayed MT initiation following a COPD exacerbation that required hospitalization or an emergency department (ED) visit on COPD-related costs.

The observational cohort study used data from the retrospective databases called Truven Health MarketScan Commercial Claims and Encounters Database (commercial) and Medicare Supplemental and Coordination of Benefits Database (Medicare supplement). Researchers used patients with COPD exacerbations that resulted in hospitalization or ED visits.

The enrollment period was January 1, 2009 to June 30, 2012. In the study, the index date was defined as the date of the first hospital discharge or ED visit for COPD exacerbation.

A 1-year pre-index period was used for baseline assessment, and a 1-year follow-up period that started on the index date was used to evaluate the study outcomes. MT included LABAs, LAMAs, methylxanthines, and combinations of LABA/LAMA/ICS, and excluded ICS monotherapy and any other unapproved COPD treatments.

Patients who initiated MT for COPD within 30 days of diagnosis or discharge (prompt) were compared with those who initiated MT within 31-180 days (delayed). To be eligible for the study, patients were required to be ≥40 years of age, and continuously enrolled in a health plan during the pre-index and follow-up periods.

To evaluate for COPD-related total, medical, and prescription drug costs during the 1-year follow-up period, researchers used semilog ordinary least square regressions. They controlled for baseline characteristics, plus COPD-related costs from the previous year.

During the follow-up, the odds and number of COPD-related exacerbations were compared between the prompt and delayed cohorts using logistic regression and zero-inflated negative binomial models, respectively.

There was a total of 6521 patients with COPD-related hospitalizations or ED visits included in the study. Of the total participants, 4555 (69.9%) of patients received prompt MT, and 1966 (30.1%) received delayed MT.

More than half (55.1%) of patients were female, and 53.5% were 65-years-old or older. The results of the study showed that overall, 31.8% of the study sample had at least 1 subsequent exacerbation in the 1-year follow-up period.

Patients who received delayed MT were 68% more likely to have a subsequent exacerbation that required hospitalization, and 80% were more likely to have an exacerbation that required a visit to the ED. After adjusting for baseline covariates, post-index COPD-related costs were significantly lower for the prompt MT cohort ($3,931, 95% CI: $1,438 - $11,519) compared to the delayed MT cohort ($4857, 95% CI: $1,900 — $13,310; P<0.010).

The findings revealed an association between prompt initiation of MT within 30 days following discharge from a COPD-related hospitalization, or an ED visit and a significant reduction in COPD-related costs and odds of exacerbations in the following year compared with delayed MT initiation.