Burden of Exacerbations in Patients Newly Initiating an Inhaled Regimen for COPD: A Claims Analysis.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive disease that has a great impact on healthcare resource utilization (HRU). Large-scale real-world evidence studies evaluating the clinical and economic impact of current maintenance inhaler therapies are scarce.

OBJECTIVE

To assess annual exacerbation rate and COPD-related HRU in patients with COPD before and after initiation of an inhaled treatment regimen.

METHODS

The Optum Clinformatics Data Mart database was used to identify inpatient, outpatient, and pharmacy claims from patients aged ≥40 years with COPD in the United States from January 2016 to June 2023. The index date was the date of the first prescription claim for a new inhaled maintenance therapy after a 12-month maintenance treatment-free baseline period. The primary outcome was the proportion of patients with ≥1 moderate/severe exacerbation within 12 months post-index. The average number of moderate/severe exacerbations per patient and the proportion of patients with inpatient, emergency department (ED), office, and outpatient visits within 12 months post-index were also assessed.

RESULTS

Of the 137,691 included patients, 51.5% were female and 74.6% were White, with a mean (standard deviation [SD]) age of 70.9 (9.49) years and a mean (SD) Elixhauser Comorbidity Index of 5.67 (3.29). Most (48.3%) patients were initiated on long-acting beta-agonists/inhaled corticosteroids (LABA/ICS). The proportions of patients with exacerbations significantly decreased overall (pre-index, 45.5%; post-index, 37.0%; < 0.001). However, more than one-third of patients still experienced an exacerbation 12 months after initiating treatment. The proportion of patients with COPD-related HRU generally decreased; however, 5.0% and 2.9% of patients had inpatient and ED care post-index, respectively.

CONCLUSION

Despite use of inhaled treatments for COPD, patients continue to experience exacerbations and HRU. Better implementation of guideline-based COPD care and novel therapies for persistent exacerbation burden are needed to improve care of the COPD population in real-world settings.