Burden of Disease Among Exacerbating Patients with COPD Treated with Triple Therapy in Spain

Abstract

Background:The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy. Methods: An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients ≥40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of ≥2 moderate or ≥1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to €2019. Patients were classified according to blood eosinophil levels: <150 cells/µL and ≥150 cells/µL. Results: A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had ≥150 cells/µL eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils ≥150 cells/µL, whereas in severe exacerbation was higher in patients with eosinophils <150cells/ µL. According to eosinophil levels, total annual mean (SD) costs/patient accounted for €8382 (9863) and €5144 (5444) for patients with eosinophils <150 cells/µL and ≥150 cells/µL, respectively. Conclusion:The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/µL.

Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy

“…This represents approximately 3.0% (n=1287/43,753) of the entire maintenance-treated cohort, which is a slightly higher proportion than the proportion of patients with asthma who have severe, uncontrolled eosinophilic disease despite therapy (<1%), according to a large analysis of patients with asthma who were receiving systemic corticosteroids. 26 Despite the small size of the group, patients with severe, uncontrolled eosinophilic asthma experience a nearly four-fold increase in HCRU events and a four-fold increase in costs (£861.0 vs £222.0 per year) compared with all patients with asthma. 27 This is similar to the findings in our cohort, which revealed that individuals with severe COPD and frequent exacerbations experience a significantly higher number of HCRU events than the general COPD population, even though they are receiving maximal, guideline-directed therapy.…”

“…Our findings support those of another observational study that demonstrated substantial HCRU, costs, and exacerbation rates among patients with COPD who were receiving triple therapy but continued to experience exacerbations. 26 Of patients who experienced exacerbations despite receiving triple therapy, nearly one-quarter (n=1287/5669; 22.7%) had BEC ≥250 cells/µL and experienced ≥3 exacerbations in the year prior to the index date. This represents approximately 3.0% (n=1287/43,753) of the entire maintenance-treated cohort, which is a slightly higher proportion than the proportion of patients with asthma who have severe, uncontrolled eosinophilic disease despite therapy (<1%), according to a large analysis of patients with asthma who were receiving systemic corticosteroids.…”

“…Our findings support those of another observational study that demonstrated substantial HCRU, costs, and exacerbation rates among patients with COPD who were receiving triple therapy but continued to experience exacerbations. 26 …”

“… 30 Together, these findings support the need for adequate treatment of underlying eosinophilic inflammation for patients with COPD as well as for those who are not adequately responding to the highest concentrations of inhaler therapy. 29 The role of eosinophilia in COPD remains unclear, and no reliable threshold of blood eosinophilia has been identified to discriminate a higher risk of exacerbations, 18 , 26 , 31 but BEC is showing promise as a marker of COPD outcomes.…”

“…International Journal of Chronic Obstructive Pulmonary Disease 2022:17 2196 eosinophilia has been identified to discriminate a higher risk of exacerbations, 18,26,31 but BEC is showing promise as a marker of COPD outcomes.…”