<p>Exacerbations and health care resource use among patients with COPD in relation to blood eosinophil counts</p>

Abstract

PurposeCurrent understanding of the relationship between COPD phenotype and health care resource utilization (HCRU) is limited. This real-world study evaluated disease burden and HCRU for COPD subgroups prone to exacerbation as defined by blood eosinophil (EOS) count and multiple inhaler triple therapy (MITT) use.MethodsThis was a large-scale, retrospective, longitudinal, observational cohort study using data from the US IBM Watson Explorys real-world database (GSK Study HO-17-18395). The population of interest comprised patients with COPD ≥40 years of age with ≥2 moderate or ≥1 severe exacerbations (prior year) while on inhaled maintenance therapy, with ≥1 blood EOS count. Data were analyzed during the year prior to index date (last COPD encounter between January 1, 2011 and December 31, 2016). Four subgroups were analyzed based on a combination of EOS counts (<150 and ≥150 cells/μL) and MITT use (receiving or not receiving). Among these groups, clinical characteristics, exacerbations, and HCRU were described. A sensitivity analysis that further stratified EOS into four categories (<150, ≥150–<300, ≥300–<500, and ≥500 cells/μL) was also performed.ResultsThe COPD population of interest comprised 34,268 patients. Subgroups with EOS ≥150 cells/μL vs <150 cells/μL had more comorbidities and experienced significantly higher mean numbers of moderate exacerbations (not receiving MITT, ≥150 cells/μL vs <150 cells/μL: 1.93 vs 1.82, P<0.0001; receiving MITT 2.26 vs 2.16, P=0.0062) and COPD-related emergency visits (not receiving MITT, ≥150 cells/μL vs <150 cells/μL: 3.0 vs 2.5, P<0.001; receiving MITT 3.4 vs 3.1, P=0.0011). Increasing EOS category was associated with higher HCRU.ConclusionBlood EOS ≥150/μL cells were associated with increased HCRU and higher exacerbation rates compared with EOS <150 cells/μL, irrespective of MITT use. COPD phenotyping using blood EOS could help identify candidates for additional therapies that target eosinophilic inflammatory pathways.

<p>Clinical And Economic Burden Of Eosinophilic COPD In A Large Retrospective US Cohort</p>

“…12 In another recent study based on EMR data linked to claims with a large sample size across many care settings in the United States, Mullerova et al found that blood eosinophil counts ≥150 cells/µL were associated with increased HCRU and higher exacerbation rates compared with blood eosinophil counts <150 cells/μL. 13 The current study has several strengths. Our study was based on a large population of COPD patients identified from a single ambulatory EMR system in use in all 50 states and includes linkage to a large transactional claims database that captures a large percentage of the prescription, medical, and hospital claims in the United States.…”

“…11 Two recent US studies on patients with COPD have also found an increase in healthcare resource utilization with increasing eosinophil count. 12,13 This retrospective, observational database study of COPD patients spanning multiple real-world US practice settings is the first comprehensive evaluation of the association of blood eosinophil counts with health care utilization and cost outcomes reflecting current clinical practice across the US. The aims of this cohort study were to describe patient characteristics, health care utilization and cost across groups with increasing blood eosinophil counts in a broadly representative COPD patient population.…”

Blood Eosinophils and Clinical Outcomes in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Analysis of Real-World Data in China

“…Several studies demonstrated a substantial annual burden associated with eosinophilic COPD ( 29 , 30 ). In a cross-sectional study of 2,832 patients in the US, subjects with elevated eosinophil counts had numerically higher all-cause and COPD-related health care resource utilization (HCRU) and cost each year ( 31 ).…”

Long‐term oxygen treatment need is less frequent in eosinophilic COPD patients

“…Similarly, number of COPD‐related in‐patient days within severe COPD patients and overall mortality for all COPD patients were greater in noneosinophilic COPD patients in the study from Finland 37 . However, there are some studies indicating an association between elevated blood eosinophil count and exacerbations 38,39 . Vedel‐Krogh et al calculated a 1.76‐fold increased risk of severe exacerbation related with high blood eosinophil counts 18 .…”

“… 37 However, there are some studies indicating an association between elevated blood eosinophil count and exacerbations. 38 , 39 Vedel‐Krogh et al calculated a 1.76‐fold increased risk of severe exacerbation related with high blood eosinophil counts. 18 Kerkhof et al found an elevated risk exacerbation related with eosinophils but only in ex‐smoker COPD population.…”