Respiratory and Inflammation Therapeutic Area, AstraZeneca, Wilmington, DE, USA.
Life Sciences, Practice Fusion, San Francisco, CA, USA.
Int J Chron Obstruct Pulmon Dis. 2019 Nov 26;14:2625-2637. doi: 10.2147/COPD.S220009. eCollection 2019.
We sought to describe clinical and economic outcomes for COPD patients by blood eosinophil (EOS) count.
This retrospective cohort study of COPD patients used data from the Practice Fusion electronic medical records (EMR) database linked to Symphony Health Solutions transactional pharmacy, medical, outpatient, and inpatient claims data to evaluate COPD-related and all-cause health care resource utilization and cost in the 12-month period following the date of each patient's greatest recorded blood eosinophil count during the 27-month period from January 2014 to March 2016. A post-index moderate exacerbation was defined as an outpatient or emergency care visit for COPD and a prescription for oral corticosteroid and/or antibiotics within 10 days of the visit. Severe exacerbation was defined as an inpatient hospitalization with COPD as primary diagnosis.
Of 48,090 EMR patients, 39,939 (83.1%) had a charge in the claims data both pre- and post-index (mean age 67.2 years, 58.3% female), 17,397 (43.6%) had EOS ≥220 cells/µL. Moderate and severe exacerbations were more frequent for patients with EOS≥220 cells/µL compared with those with EOS <220 cells/µL (moderate: 6.8% vs 6.1%, p<0.05; severe: 3.1% vs 2.5%, p<0.001). After adjustment for baseline clinical characteristics, each 100-unit increase in EOS count was associated with a significant 2.24% increase in total all-cause costs and 4.54% increase in total COPD-related costs (p<0.001 for both). COPD-related costs were significantly greater for patients with an EOS count of ≥220 cells/µL compared with those with EOS <220 cells/µL (p<0.001). These costs appear to have been driven by a greater percentage of patients in the ≥220 cells/µL cohort with COPD-related resource use including hospitalization, office visits, ambulatory procedures and pharmacy prescriptions.
COPD patients with EOS counts ≥220 cells/µL were more likely to have had moderate or severe exacerbations and greater cost of care than those with EOS <220 cells/µL.
我们旨在通过血液嗜酸性粒细胞（EOS）计数来描述 COPD 患者的临床和经济结局。
这项针对 COPD 患者的回顾性队列研究使用了来自 Practice Fusion 电子病历（EMR）数据库的数据，该数据库与 Symphony Health Solutions 的交易性药房、医疗、门诊和住院索赔数据相关联，以评估在 2014 年 1 月至 2016 年 3 月的 27 个月期间每个患者记录的最大血液嗜酸性粒细胞计数后 12 个月内与 COPD 相关的和所有原因的医疗资源利用和成本。中度加重被定义为 COPD 的门诊或急诊就诊，以及在就诊后 10 天内开出口服皮质类固醇和/或抗生素的处方。重度加重被定义为因 COPD 为主要诊断而住院的住院治疗。
在 48090 名 EMR 患者中，有 39939 名（83.1%）在索赔数据中有收费，在指数前和指数后（平均年龄 67.2 岁，58.3%为女性），17397 名（43.6%）EOS≥220 细胞/µL。与 EOS<220 细胞/µL 的患者相比，EOS≥220 细胞/µL 的患者发生中度和重度加重的频率更高（中度：6.8%比 6.1%，p<0.05；重度：3.1%比 2.5%，p<0.001）。在校正基线临床特征后，EOS 计数每增加 100 个单位，与总全因费用增加 2.24%和 COPD 相关费用增加 4.54%显著相关（两者均<0.001）。与 EOS<220 细胞/µL 的患者相比，EOS 计数≥220 细胞/µL 的患者的 COPD 相关费用显著更高（p<0.001）。这些成本似乎是由更高比例的 EOS 计数≥220 细胞/µL 患者的 COPD 相关资源使用（包括住院、门诊就诊、门诊程序和药房处方）驱动的。
EOS 计数≥220 细胞/µL 的 COPD 患者比 EOS<220 细胞/µL 的患者更有可能发生中度或重度加重，并且医疗费用更高。
