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Pimentel VD, Acha BT, Gomes GF, Macedo de Sousa Cardoso JL, Sena da Costa CL, Carvalho Batista NJ, Rufino Arcanjo DD, Alves WDS, de Assis Oliveira F. Anti-inflammatory effect of Anadenanthera colubrina var. cebil (Griseb.) Altschul in experimental elastase-induced pulmonary emphysema in rats. JOURNAL OF ETHNOPHARMACOLOGY 2024; 332:118216. [PMID: 38642622 DOI: 10.1016/j.jep.2024.118216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Medicinal plants have shown promise in the search for new treatments of pulmonary emphysema. Anadenanthera colubrina, a species native to the Caatinga biome in northeastern Brazil, is widely recognized and traditionally employed in the treatment of pulmonary diseases. Many studies corroborate popular knowledge about the medicinal applications of A. colubrina, which has demonstrated a remarkable variety of pharmacological properties, however, its anti-inflammatory and antioxidant properties are highlighted. AIM OF THE STUDY The objective of this study was to investigate the anti-inflammatory potential of the crude hydroethanolic extract of A. colubrina var. cebil (Griseb.) Altschul on pulmonary emphysema in rats as well as to determine its potential genotoxic and cytotoxic effects using the micronucleus assay. MATERIALS AND METHODS The stem bark of the plant was collected in Pimenteiras-PI and sample was extracted by maceration using 70% ethanol. A portion of the extract underwent phytochemical analyses using TLC and HPLC. In this study, 8-week-old, male Wistar rats weighing approximately ±200 g was utilized following approval by local ethics committee for animal experimentation (No. 718/2022). Pulmonary emphysema was induced through orotracheal instillation of elastase, and treatment with A. colubrina extract or dexamethasone (positive control) concomitantly during induction. Twenty-eight days after the initiation of the protocol, plasma was used for cytokine measurement. Bronchoalveolar lavage (BAL) was used for leukocyte count. After euthanasia, lung samples were processed for histological analysis and quantification of oxidative stress markers. The micronucleus test was performed by evaluating the number of polychromatic erythrocytes (PCE) with micronuclei (MNPCE) to verify potential genotoxic effects of A. colubrina. A differential count of PCE and normochromatic erythrocytes (NCE) was performed to verify the potential cytotoxicity of the extract. Parametric data were subjected to normality analysis and subsequently to analysis of variance and Tukey or Dunnett post-test, non-parametric data were treated using the Kruskal-Wallis test with Dunn's post-test for unpaired samples. P value < 0.05 were considered significant. RESULTS The A. colubrina extract did not show a significant increase in the number of MNPCE (p > 0.05), demonstrating low genotoxicity. No changes were observed in the PCE/NCE ratio of treated animals, compared with the vehicle, suggesting low cytotoxic potential of the extract. A significant reduction (p < 0.05) in neutrophilic inflammation was observed in the lungs of rats treated with the extract, evidenced by presence of these cells in both the tissue and BAL. The extract also demonstrated pulmonary antioxidant activity, with a significant decrease (p < 0.05) in myeloperoxidase, malondialdehyde, and nitrite levels. TNFα, IL-1β, and IL-6 levels, as well as alveolar damage, were significantly reduced in animals treated with A. colubrina extract. Phytochemical analyses identified the presence of phenolic compounds and hydrolysable tannins in the A. colubrina extract. CONCLUSIONS The findings of this study highlights the safety of the hydroethanolic extract of Anadenanthera colubrina, and demonstrates its potential as a therapeutic approach in the treatment of emphysema. The observed properties of this medicinal plant provide an optimistic outlook in the development of therapies for the treatment of pulmonary emphysema.
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Affiliation(s)
- Vinicius Duarte Pimentel
- Laboratory of Inflammation Pharmacology (LAFIN), Medicinal Plants Research Center, Federal University of Piauí, Teresina, Piauí, Brazil.
| | - Boris Timah Acha
- Laboratory of Functional and Molecular Studies in Physiopharmacology (LAFMOL), Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Gabriel Felicio Gomes
- Laboratory of Inflammation Pharmacology (LAFIN), Medicinal Plants Research Center, Federal University of Piauí, Teresina, Piauí, Brazil
| | - João Luiz Macedo de Sousa Cardoso
- Laboratory of Inflammation Pharmacology (LAFIN), Medicinal Plants Research Center, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Charllyton Luis Sena da Costa
- Laboratory of Inflammation Pharmacology (LAFIN), Medicinal Plants Research Center, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Nelson Jorge Carvalho Batista
- Laboratory of Inflammation Pharmacology (LAFIN), Medicinal Plants Research Center, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Daniel Dias Rufino Arcanjo
- Laboratory of Functional and Molecular Studies in Physiopharmacology (LAFMOL), Department of Biophysics and Physiology, Federal University of Piauí, Teresina, Piauí, Brazil
| | - Wellington Dos Santos Alves
- Laboratory of Natural Products and Bioprospection (LabPNBio), State University of Piauí, Teresina, Piauí, Brazil
| | - Francisco de Assis Oliveira
- Laboratory of Inflammation Pharmacology (LAFIN), Medicinal Plants Research Center, Federal University of Piauí, Teresina, Piauí, Brazil
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De la Fuente JRO, Greenberg P, Sunderram J. The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease. J Clin Sleep Med 2024; 20:863-870. [PMID: 38189375 PMCID: PMC11145048 DOI: 10.5664/jcsm.11000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVES This study examined in-hospital outcomes for patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also known as COPD-OSA overlap syndrome, during hospitalizations for acute exacerbation of COPD. METHODS The National Inpatient Sample was used to examine in-hospital mortality, length of stay, costs, and utilization of supportive ventilation in patients with COPD-OSA overlap during acute exacerbation of COPD hospitalizations. A 1-to-1 matched case-control design was utilized to match patients with and without OSA. Multivariate logistic regression modeling was used to examine mortality and ventilatory support, while controlling for potentially confounding diagnoses. RESULTS COPD-OSA overlap was associated with longer median length of stay (4 days OSA, 3 days non-OSA; P < .001), higher mean costs ($32,197 OSA, $29,011 non-OSA; P < .001), increased utilization of noninvasive positive-pressure ventilation (13.92% OSA, 6.78% non-OSA; P < .001), and when required for greater than 96 hours, earlier initiation of mechanical ventilation (2.53 days OSA, 3.35 days non-OSA; P = .001). However, COPD-OSA overlap was associated with reduced mortality (0.81% OSA, 1.05% non-OSA; P < .001). These differences in mortality (adjusted odds ratio: 0.650; 95% confidence interval: 0.624-0.678) and noninvasive positive-pressure ventilation usage (adjusted odds ratio: 1.998; 95% confidence interval: 1.970-2.026) remained when adjusted for confounders. CONCLUSIONS Patients with COPD-OSA overlap have higher utilization of supportive ventilation and longer length of stay during acute exacerbation of COPD hospitalizations, contributing to higher costs. The diagnosis of OSA is associated with reduced mortality in these hospitalizations, which may be related to greater utilization of supportive ventilation when OSA is recognized. CITATION De la Fuente JRO, Greenberg P, Sunderram J. The overlap of chronic obstructive pulmonary disease and obstructive sleep apnea in hospitalizations for acute exacerbation of chronic obstructive pulmonary disease. J Clin Sleep Med. 2024;20(6):863-870.
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Affiliation(s)
| | - Patricia Greenberg
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, New Brunswick, New Jersey
| | - Jag Sunderram
- Division of Pulmonary and Critical Care, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Kaushal A, Karimi DM, Nazari DR, Opare K, Museru M, Reza Nikoo DM. Environmental Exposure and Respiratory Health: Unraveling the Impact of Toxic Release Inventory Facilities on COPD Prevalence. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024:124286. [PMID: 38823548 DOI: 10.1016/j.envpol.2024.124286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024]
Abstract
This cross-sectional geospatial analysis explores the prevalence of Chronic Obstructive Pulmonary Disease (COPD) concerning the proximity to toxic release inventory (TRI) facilities in Jefferson County, Alabama. Employing the fuzzy analytical hierarchy process (FAHP), the study evaluates COPD prevalence, comorbidities, healthcare access, and individual health assessments. Given the mounting evidence linking environmental pollutants to COPD exacerbations, the research probes the influence of TRI sites on respiratory health, integrating Geographic Information Systems (GIS) to scrutinize the geospatial vulnerability of communities neighboring TRI sites. Socio-demographic disparities, economic conditions, and air pollution are emphasized in the analysis. The EPA's Toxic Release Inventory serves as the cornerstone for assessing the association between TRI proximity and COPD prevalence. The analysis uncovers a notable inverse correlation between distance from TRI sites and COPD prevalence, signaling potential health risks for populations residing closer to these facilities. Moreover, factors such as minority status, low income, and air pollution are associated with higher COPD prevalence, underscoring the imperative of comprehending the interplay between environmental exposure and respiratory health. This study bridges gaps in the literature by addressing the geographical nexus between COPD prevalence and pollution exposure. By leveraging FAHP, the research furnishes a holistic understanding of the multifaceted factors influencing vulnerability to COPD. The findings underscore the necessity for targeted public health interventions and policy measures to redress environmental disparities and alleviate the repercussions of TRI facilities on respiratory health.
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Affiliation(s)
- Aishwarya Kaushal
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Environmental Health Sciences, School of Public Health, the University of Alabama at Birmingham
| | - Dr Maryam Karimi
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Environmental Health Sciences, School of Public Health, the University of Alabama at Birmingham; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham
| | - Dr Rouzbeh Nazari
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Environmental Health Sciences, School of Public Health, the University of Alabama at Birmingham; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham.
| | - Kofi Opare
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham
| | - Mujungu Museru
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham
| | - Dr Mohammad Reza Nikoo
- Department of Civil and Architectural Engineering, Sultan Qaboos University, Muscat, Oman
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Strange C, Tkacz J, Schinkel J, Lewing B, Agatep B, Swisher S, Patel S, Edwards D, Touchette DR, Portillo E, Feigler N, Pollack M. Exacerbations and Real-World Outcomes After Single-Inhaler Triple Therapy of Budesonide/Glycopyrrolate/Formoterol Fumarate, Among Patients with COPD: Results from the EROS (US) Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2245-2256. [PMID: 37849918 PMCID: PMC10577086 DOI: 10.2147/copd.s432963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Triple therapy to prevent exacerbations from chronic obstructive pulmonary disease (COPD) is associated with improved health compared to single and dual-agent therapy in some populations. This study assessed the benefits of prompt administration of budesonide/glycopyrrolate/formoterol fumarate (BGF) following a COPD exacerbation. Patients and methods EROS was a retrospective analysis of people with COPD using the MORE2 Registry®. Inclusion required ≥1 severe, ≥2 moderate, or ≥1 moderate exacerbation while on other maintenance treatment. Within 12 months following the index exacerbation, ≥1 pharmacy claim for BGF was required. Primary outcomes were the rate of COPD exacerbations and healthcare costs for those that received BGF promptly (within 30 days of index exacerbation) versus delayed (31-180 days) and very delayed (181-365 days). The effect of each 30-day delay in initiation of BGF was estimated using a multivariable negative binomial regression model. Results 2409 patients were identified: 434 prompt, 1187 delayed, and 788 very delayed. The rate (95% CI) of total exacerbations post-index increased as time to BGF initiation increased: prompt 1.52 (1.39-1.66); delayed 2.00 (1.92-2.09); and very delayed 2.30 (2.20-2.40). Adjusting for patient characteristics, each 30-day delay in receiving BGF was associated with a 5% increase in the average number of subsequent exacerbations (rate ratio, 95% CI: 1.05, 1.01-1.08; p<0.05). Prompt initiation of BGF was also associated with lower post-index annualized COPD-related costs ($5002 for prompt vs $7639 and $8724 for the delayed and very delayed groups, respectively). Conclusion Following a COPD exacerbation, promptly initiating BGF was associated with a reduction in subsequent exacerbations and reduced healthcare utilization and costs.
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Affiliation(s)
- Charlie Strange
- College of Medicine, The Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | - Sean Swisher
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Sushma Patel
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | | | - Daniel R Touchette
- College of Pharmacy - Pharmacy Systems Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Edward Portillo
- Pharmacy Practice & Translational Research Division, University of Wisconsin-Madison, Madison, WI, USA
| | - Norbert Feigler
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Michael Pollack
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
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Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev 2023; 32:32/167/220170. [PMID: 36948501 PMCID: PMC10032611 DOI: 10.1183/16000617.0170-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023] Open
Abstract
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Shared first authorship
| | | | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeannette Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Verkleij
- Department of Paediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Luyster FS, Boudreaux-Kelly MY, Bon JM. Insomnia in chronic obstructive pulmonary disease and associations with healthcare utilization and costs. Respir Res 2023; 24:93. [PMID: 36964552 PMCID: PMC10039604 DOI: 10.1186/s12931-023-02401-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
Insomnia has been linked to adverse chronic obstructive pulmonary disease (COPD) outcomes including exacerbations, yet its impact on COPD-related healthcare utilization and costs is unknown. In this study, we investigated the associations between insomnia and healthcare utilization and costs in patients with COPD. A retrospective cohort of veterans with COPD were identified from national Veterans Affairs administration data for fiscal years 2012-2017. Insomnia was operationalized as having an insomnia diagnosis based on International Classification of Disease codes or having a prescription of > 30 doses of a sedative-hypnotic medication in a given fiscal year. The index date for insomnia was the first date when dual criteria for COPD and insomnia was met. The index date for those without insomnia was set as the COPD index date. Our primary outcomes were 1-year healthcare utilization and costs related to outpatient visits and hospitalizations after index date. COPD-related healthcare utilization variables included number of prescription fills of corticosteroids and/or antibiotics and outpatient visits and hospitalizations with a primary diagnosis of COPD. Out of 1,011,646 patients (96% men, mean age 68.4 years) diagnosed with COPD, 407,363 (38.8%) had insomnia. After adjustment for confounders, insomnia was associated with higher rates of outpatient visits, hospitalizations, and fills for corticosteroids and/or antibiotics, longer hospital length of stay, and $10,344 higher hospitalization costs in the 12 months after index date. These findings highlight the importance of insomnia as a potentially modifiable target for reducing the burden of COPD on patients and healthcare systems.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria St, 415 Victoria Building, Pittsburgh, PA, 15241, USA.
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | - Jessica M Bon
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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Crisafulli E, Sartori G, Vianello A, Busti F, Nobili A, Mannucci PM, Girelli D. Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both. Intern Emerg Med 2023; 18:523-534. [PMID: 36773107 PMCID: PMC10017574 DOI: 10.1007/s11739-023-03207-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. METHODS We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. RESULTS We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). CONCLUSION In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population.
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Affiliation(s)
- Ernesto Crisafulli
- Respiratory Medicine Unit and Section of Internal Medicine, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Largo L. A. Scuro, 10, 37124, Verona, Italy.
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Giulia Sartori
- Respiratory Medicine Unit and Section of Internal Medicine, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Largo L. A. Scuro, 10, 37124, Verona, Italy
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alice Vianello
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandro Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Evans KA, Pollack M, Portillo E, Strange C, Touchette DR, Staresinic A, Patel S, Tkacz J, Feigler N. Prompt initiation of triple therapy following hospitalization for a chronic obstructive pulmonary disease exacerbation in the United States: An analysis of the PRIMUS study. J Manag Care Spec Pharm 2022; 28:1366-1377. [PMID: 36427341 PMCID: PMC10372961 DOI: 10.18553/jmcp.2022.28.12.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND: Severe exacerbations requiring hospitalization contribute a substantial portion of the morbidity and costs of chronic obstructive pulmonary disease (COPD). Triple therapy (inhaled corticosteroid + long-acting β-agonist + long-acting muscarinic antagonist) is a recommended option for patients who experience recurrent COPD exacerbations or persistent symptoms. Few real-world studies have specifically examined the effect of prompt initiation of triple therapy, specifically among patients hospitalized for a COPD exacerbation. OBJECTIVE: To assess whether prompt initiation of triple therapy following a severe COPD exacerbation was associated with lower risk of subsequent exacerbations and lower health care use and costs and the effects of each 30-day delay of initiation. METHODS: Adults aged 40 years or older with COPD were identified in the Merative MarketScan Databases between January 1, 2010, and December 31, 2019, and were required to meet the following criteria: open or closed triple therapy (date of first closed prescription or last component of open=index treatment date), more than 1 inpatient admission with a primary COPD diagnosis (ie, severe exacerbation) in the prior 12 months (index exacerbation), 12 months of continuous enrollment before (baseline) and after (follow-up) index exacerbation, and absence of select respiratory diseases and cancer. Patients were stratified based on timing of open or closed triple therapy after the index exacerbation: prompt (≤30 days), delayed (31-180 days), or very delayed (181-365 days). Multivariable regression controlled for baseline characteristics (age, sex, insurance type, index year, comorbidities, prior treatment, and prior exacerbations) and estimated the odds of subsequent exacerbations, change in the number of exacerbations, and change in health care costs during 12-month follow-up associated with each 30-day delay of triple therapy initiation. RESULTS: A total of 6,772 patients met inclusion criteria (2,968 [43.8%] prompt, 1,998 [29.5%] delayed, and 1,806 [26.7%] very delayed). The adjusted odds of any exacerbation and a severe exacerbation during 12-month follow-up increased by 13% (odds ratio [95% CI]: 1.13 [1.11-1.15]) and 10% (1.10 [1.08-1.12]), respectively, for each 30-day delay in triple therapy initiation, and the mean number of exacerbations increased by 5.4% (95% CI = 4.7%-6.1%). There was a 3.0% increase (95% CI = 2.2%-3.8%) in mean all-cause costs and a 3.7% increase (95% CI = 2.9%-4.6%) in total COPD-related costs for each 30-day delay of triple therapy initiation. CONCLUSIONS: Longer delays in triple therapy initiation after a COPD hospitalization result in greater risk of subsequent exacerbations and higher health care resource use and costs. Adequate post-discharge follow-up care and earlier consideration of triple therapy may improve clinical and economic outcomes among patients with COPD. DISCLOSURES: This study was funded by AstraZeneca. Dr Evans is employed by Merative, formerly IBM Watson Health, and Mr Tkacz was employed by IBM Watson Health at the time of this study; Merative/IBM Watson Health received funding from AstraZeneca to conduct this study. Mr Pollack, Dr Staresinic, Dr Feigler, and Dr Patel are employed by AstraZeneca. Dr Touchette, Dr Portillo, and Dr Strange are paid consultants to AstraZeneca. Dr Strange also participates in research grants paid to the Medical University of South Carolina by AstraZeneca, CSA Medical, and Nuvaira, and is a consultant to GlaxoSmithKline, Morair, and PulManage regarding COPD.
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Affiliation(s)
- Kristin A Evans
- Real World Data Research and Analytics, Merative, Ann Arbor, MI
| | | | - Edward Portillo
- Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy
| | - Charlie Strange
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston
| | - Daniel R Touchette
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois College of Pharmacy, Chicago
| | | | - Sushma Patel
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE
| | - Joseph Tkacz
- Life Sciences, IBM Watson Health, Cambridge, MA, now with Inovalon, Washington DC
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9
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Sterling KL, Pépin JL, Linde-Zwirble W, Chen J, Benjafield AV, Cistulli PA, Cole KV, Emami H, Woodford C, Armitstead JP, Nunez CM, Wedzicha JA, Malhotra A. Impact of Positive Airway Pressure Therapy Adherence on Outcomes in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2022; 206:197-205. [PMID: 35436176 PMCID: PMC9887426 DOI: 10.1164/rccm.202109-2035oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rationale: The co-occurrence of obstructive sleep apnea and chronic obstructive pulmonary disease, termed overlap syndrome, has a poor prognosis. However, data on positive airway pressure (PAP) treatments and their impact on outcomes and costs are lacking. Objectives: This retrospective observational study investigated the effects of PAP on health outcomes, resource usage, and costs in patients with overlap syndrome. Methods: Deidentified adjudicated claims data for patients with overlap syndrome in the United States were linked to objectively measured PAP user data. Patients were considered adherent to PAP therapy if they met Centers for Medicare and Medicaid Services criteria for eight 90-day timeframes from device setup through 2-year follow-up. Propensity score matching was used to create comparable groups of adherent and nonadherent patients. Healthcare resource usage was based on the number of doctor visits, all-cause emergency room visits, all-cause hospitalizations, and PAP equipment and supplies, and proxy costs were obtained. Measurements and Main Results: A total of 6,810 patients were included (mean age, 60.8 yr; 56% female); 2,328 were nonadherent. Compared with the year before therapy, there were significant reductions in the number of emergency room visits, hospitalizations, and severe acute exacerbations during 2 years of PAP therapy in patients who were versus were not adherent (all P < 0.001). This improvement in health status was paralleled by a significant reduction in the associated healthcare costs. Conclusions: PAP usage by patients with overlap syndrome was associated with reduced all-cause hospitalizations and emergency room visits, severe acute exacerbations, and healthcare costs.
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Affiliation(s)
| | - Jean-Louis Pépin
- Institut National de la Santé et de la Recherche Médicale U 1300, HP2 Laboratory (Hypoxia: Pathophysiology), Grenoble Alpes University, Grenoble, France
| | | | | | | | - Peter A. Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | | | | | | | | | - Jadwiga A. Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Atul Malhotra
- University of California San Diego, La Jolla, California
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10
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Larsson K, Lisspers K, Ställberg B, Johansson G, Gutzwiller FS, Mezzi K, Bjerregaard BK, Jorgensen L, Koo H, Janson C. Treatment Patterns, Socioeconomic Status and Clinical Burden in Mild COPD: A Swedish Real-World, Retrospective Cohort Study, the ARCTIC Study. Int J Chron Obstruct Pulmon Dis 2022; 17:1409-1421. [PMID: 35761954 PMCID: PMC9233559 DOI: 10.2147/copd.s364932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Patients with mild chronic obstructive pulmonary disease (COPD) account for more than half of the total COPD population but are often undiagnosed and sparsely studied. This real-world, longitudinal study compared the socioeconomic burden, clinical characteristics and treatment patterns in patients with mild COPD and age- and gender-matched controls. Patients and methods Our population included mild COPD patients (forced expiratory volume in one second ≥80% of predicted value) and reference controls from 52 Swedish primary care centres over 15 years (2000-2014). We linked electronic medical record (EMR) data to Sweden's National Health Registries. The outcomes analyzed were socioeconomic status including annual income from work, presence of comorbidities and the use of medications. Results 844 patients with mild COPD were included in this study and matched with 844 reference controls. Compared with the reference controls, mild COPD patients had a significantly lower annual income from work (mean difference, men: 12,559€ and women: 7143€) and were significantly less likely to be married or employed. The presence of comorbidities, including cardiovascular disease, anxiety and depression (only women) was significantly higher in mild COPD patients. The use of medications, such as proton pump inhibitors, antidepressants, central painkillers and sleep medications, was significantly higher in the mild COPD group. Conclusion Mild COPD presents a considerable socioeconomic and clinical burden compared with reference controls The findings suggest that COPD constitutes a condition that influences health status even in mild disease clearly demanding an increased need for early detection and treatment.
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Affiliation(s)
- Kjell Larsson
- Integrative Toxicology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Gunnar Johansson
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | | | | | | | | | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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11
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Santos NCD, Miravitlles M, Camelier AA, Almeida VDCD, Maciel RRBT, Camelier FWR. PREVALENCE AND IMPACT OF COMORBIDITIES IN INDIVIDUALS WITH COPD: A SYSTEMATIC REVIEW. Tuberc Respir Dis (Seoul) 2022; 85:205-220. [PMID: 35618259 PMCID: PMC9263346 DOI: 10.4046/trd.2021.0179] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to describe the prevalence of comorbidities associated with chronic obstructive pulmonary disease (COPD) and their relation with relevant outcomes. A systematic review based on the PRISMA methodology was performed from January 2020 until July 2021. The MEDLINE, Lilacs, and Scielo databases were searched to identify studies related to COPD and its comorbidities. Observational studies on the prevalence of comorbidities in COPD patients and costs with health estimates, reduced quality of life, and mortality were included. Studies that were restricted to one or more COPD pain assessments and only specific comorbidities such as osteoporosis, bronchitis, and asthma were excluded. The initial search identified 1,409 studies and after applying the inclusion and exclusion criteria, 20 studies were finally selected for analysis (comprising data from 447,459 COPD subjects). The most frequent COPD comorbidities were: hypertension (range, 17%–64.7%), coronary artery disease (19.9%–47.8%), diabetes (10.2%–45%), osteoarthritis (18%–43.8%), psychiatric conditions (12.1%–33%), and asthma (14.7%–32.5%). Several comorbidities had an impact on the frequency and severity of COPD exacerbations, quality of life, and mortality risk, in particular malignancies, coronary artery disease, chronic heart failure, and cardiac arrhythmias. Comorbidities, especially cardiovascular diseases and diabetes, are frequent in COPD patients, and some of them are associated with higher mortality.
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12
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Tkacz J, Evans KA, Touchette DR, Portillo E, Strange C, Staresinic A, Feigler N, Patel S, Pollack M. PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2022; 17:329-342. [PMID: 35177901 PMCID: PMC8843423 DOI: 10.2147/copd.s347735] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with chronic obstructive pulmonary disease (COPD) may experience moderate (requiring outpatient care) or severe (requiring hospitalization) disease exacerbations. Guidelines recommend escalation from dual to triple therapy (inhaled corticosteroid + long-acting beta agonist + long-acting muscarinic antagonist) after two moderate or one severe exacerbation in a year. This study examined whether prompt initiation of triple therapy lowers risk of future exacerbations and reduces healthcare costs, compared to delayed/very delayed triple therapy after an exacerbation. Patients and Methods This retrospective observational study of US healthcare claims included patients ≥40 years old with COPD who initiated triple therapy (1/1/2011–3/31/2020) after ≥2 moderate or ≥1 severe exacerbation in the prior year. The earliest of the second moderate or first severe exacerbation was the index date. Patients were stratified by triple therapy timing: prompt (≤30 days post-index), delayed (31–180 days), very delayed (181–365 days). COPD exacerbations, all-cause and COPD-related healthcare utilization and costs were assessed during 12 months post-index (follow-up). Multivariable regression estimated the effect of each 30-day delay in triple therapy on the odds of exacerbations, number of exacerbations, and costs during follow-up, controlling for patient characteristics. Results A total of 24,770 patients were included: 7577 prompt, 9676 delayed, 7517 very delayed. Each 30-day delay of triple therapy was associated with 11% and 7% increases in the odds of any exacerbation and a severe exacerbation, respectively (odds ratio [95% CI]: 1.11 [1.10–1.13] and 1.07 [1.05–1.08]), a 4.3% (95% CI: 3.9–4.6%) increase in the number of exacerbations, a 1.8% (95% CI: 1.3–2.3%) increase in all-cause costs, and a 2.1% (95% CI: 1.6–2.6%) increase in COPD-related costs during follow-up. Conclusion Promptly initiating triple therapy after two moderate or one severe exacerbation is associated with decreased morbidity and economic burden in COPD. Proactive disease management may be warranted to prevent future exacerbations and lower costs among patients with COPD.
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Affiliation(s)
- Joseph Tkacz
- Life Sciences, IBM Watson Health, Cambridge, MA, USA
| | | | - Daniel R Touchette
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois College of Pharmacy, Chicago, IL, USA
| | - Edward Portillo
- Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Charlie Strange
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Anthony Staresinic
- BioPharmaceuticals, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Norbert Feigler
- BioPharmaceuticals, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Sushma Patel
- BioPharmaceuticals, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Michael Pollack
- BioPharmaceuticals, US Medical Affairs, AstraZeneca, Wilmington, DE, USA
- Correspondence: Michael Pollack, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA, Tel +1 302 377 4911, Email
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13
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Cheng SL, Li YR, Huang N, Yu CJ, Wang HC, Lin MC, Chiu KC, Hsu WH, Chen CZ, Sheu CC, Perng DW, Lin SH, Yang TM, Lin CB, Kor CT, Lin CH. Effectiveness of Nationwide COPD Pay-for-Performance Program on COPD Exacerbations in Taiwan. Int J Chron Obstruct Pulmon Dis 2021; 16:2869-2881. [PMID: 34703221 PMCID: PMC8539057 DOI: 10.2147/copd.s329454] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It has also imposed a substantial economic and social burden on the health care system. In Taiwan, a nationwide COPD pay-for-performance (P4P) program was designed to improve the quality of COPD-related care by introducing financial incentives for health care providers and employing a multidisciplinary team to deliver guideline-based, integrated care for patients with COPD, reducing adverse outcomes, especially COPD exacerbation. However, the results of a survey of the effectiveness of the pay-for-performance program in COPD management were inconclusive. To address this knowledge gap, this study evaluated the effectiveness of the COPD P4P program in Taiwan. Methods This retrospective cohort study used data from Taiwan’s National Health Insurance claims database and nationwide COPD P4P enrollment program records from June 2016 to December 2018. Patients with COPD were classified into P4P and non-P4P groups. Patients in the P4P group were matched at a ratio of 1:1 based on age, gender, region, accreditation level, Charlson Comorbidity Index (CCI), and inhaled medication prescription type to create the non-P4P group. A difference-in-difference analysis was used to evaluate the influence of the P4P program on the likelihood of COPD exacerbation, namely COPD-related emergency department (ED) visit, intensive care unit (ICU) admission, or hospitalization. Results The final sample of 14,288 patients comprised 7144 in each of the P4P and non-P4P groups. The prevalence of COPD-related ED visits, ICU admissions, and hospitalizations was higher in the P4P group than in the non-P4P group 1 year before enrollment. After enrollment, the P4P group exhibited a greater decrease in the prevalence of COPD-related ED visits and hospitalizations than the non-P4P group (ED visit: −2.98%, p<0.05, 95% confidence interval [CI]: −0.277 to −0.086; hospitalization: −1.62%, p<0.05, 95% CI: −0.232 to −0.020), whereas no significant difference was observed between the groups in terms of the changes in the prevalence of COPD-related ICU admissions. Conclusion The COPD P4P program exerted a positive net effect on reducing the likelihood of COPD exacerbation, namely COPD-related ED visits and hospitalizations. Future studies should examine the long-term cost-effectiveness of the COPD P4P program.
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Affiliation(s)
- Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 220, Taiwan.,Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli, Taoyuan, 320, Taiwan
| | - Yi-Rong Li
- Changhua Christian Hospital, Thoracic Medicine Research Center, Changhua, 500, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan
| | - Kuo-Chin Chiu
- Division of Chest, Department of Internal Medicine, Poh-Ai Hospital, Luodong, 265, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chiung-Zuei Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, 701, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan
| | - Sheng-Hao Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, 613, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Ching-Hsiung Lin
- Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan.,Department of Recreation and Holistic Wellness, MingDao University, Changhua, 523, Taiwan
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14
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Shah CH, Onukwugha E, Zafari Z, Villalonga-Olives E, Park JE, Slejko JF. Economic burden of comorbidities among COPD Patients hospitalized for acute exacerbations: an analysis of a commercially insured population. Expert Rev Pharmacoecon Outcomes Res 2021; 22:683-690. [PMID: 34530664 DOI: 10.1080/14737167.2021.1981291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study quantifies costs associated with comorbid conditions among adults diagnosed with chronic obstructive pulmonary disease (COPD) who experience acute exacerbations (AECOPD) needing inpatient hospitalization. METHODS This retrospective cohort study used 2006-2015 IQVIA PharMetrics® Plus data, a health plan claims database. Patients aged 40-64 years, with AECOPD, defined as an inpatient hospitalization for a COPD-related diagnosis were included. The impact of comorbidities on AECOPD costs (costs of the COPD-related inpatient stay plus healthcare services used 30 days post-discharge) was determined using multivariable regression. The models adjusted for clinical complications, previous utilization, age, sex, region, year, length of hospitalization, and season of admission. RESULTS Among these COPD patients, 89.5% had at least 1 comorbidity. The mean cost for AECOPD was 2015 US $19,687 (SD: 27,035, median: 11,539). Congestive heart failure, lipid disorders, cancer, and presence of any of the 10 most frequent comorbidities were associated with $1,921 (95% confidence interval (CI): 977-2,866), $1,619 (95% CI: 967-2,272), $8,347 (95% CI: 7,236-9,458), and $4,433 (95% CI: 3,598-5,268) higher costs, respectively than corresponding individuals without these comorbid conditions. Patients with depressive disorders were associated with $1,592 (95% CI: 828-2,355) lower costs compared to those without depressive disorders. CONCLUSION COPD comorbidity imposes a significant economic burden on AECOPD.
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Affiliation(s)
- Chintal H Shah
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Jeong-Eun Park
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Julia F Slejko
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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15
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Patterns of Pulmonary Consultation for Veterans with Incident Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2021; 18:1249-1252. [PMID: 33794140 DOI: 10.1513/annalsats.202008-1075rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Le TT, Qato DM, Magder L, Bjarnadóttir M, Zafari Z, Simoni-Wastila L. Prevalence and Newly Diagnosed Rates of Multimorbidity in Older Medicare Beneficiaries with COPD. COPD 2021; 18:541-548. [PMID: 34468243 DOI: 10.1080/15412555.2021.1968815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have quantified the multimorbidity burden in older adults with chronic obstructive pulmonary disease (COPD) using large and generalizable data. Such evidence is essential to inform evidence-based research, clinical care, and resource allocation. This retrospective cohort study used a nationally representative sample of Medicare beneficiaries aged 65 years or older with COPD and 1:1 matched (on age, sex, and race) non-COPD beneficiaries to: (1) quantify the prevalence of multimorbidity at COPD onset and one-year later; (2) quantify the rates [per 100 person-years (PY)] of newly diagnosed multimorbidity during in the year prior to and in the year following COPD onset; and (3) compare multimorbidity prevalence in beneficiaries with and without COPD. Among 739,118 eligible beneficiaries with and without COPD, the average number of multimorbidity was 10.0 (SD = 4.7) and 1.0 (SD = 3.3), respectively. The most prevalent multimorbidity at COPD onset and at one-year after, respectively, were hypertension (70.8% and 80.2%), hyperlipidemia (52.2% and 64.8%), anemia (42.1% and 52.0%), arthritis (39.8% and 47.7%), and congestive heart failure (CHF) (31.3% and 38.8%). Conditions with the highest newly diagnosed rates before and following COPD onset, respectively, included hypertension (39.8 and 32.3 per 100 PY), hyperlipidemia (22.8 and 27.6), anemia (17.8 and 20.3), CHF (16.2 and 13.2), and arthritis (12.9 and 13.2). COPD was significantly associated with increased odds of all measured conditions relative to non-COPD controls. This study updates existing literature with more current, generalizable findings of the substantial multimorbidity burden in medically complex older adults with COPD-necessary to inform patient-centered, multidimensional care.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1968815 .
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Affiliation(s)
- Tham T Le
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margrét Bjarnadóttir
- Department of Decision, Operation, and Information Technologies, University of Maryland, College Park, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
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17
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Higbee D, Granell R, Walton E, Korologou-Linden R, Davey Smith G, Dodd J. Examining the possible causal relationship between lung function, COPD and Alzheimer's disease: a Mendelian randomisation study. BMJ Open Respir Res 2021; 8:8/1/e000759. [PMID: 34233891 PMCID: PMC8264898 DOI: 10.1136/bmjresp-2020-000759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/21/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022] Open
Abstract
Rationale Large retrospective case-control studies have reported an association between chronic obstructive pulmonary disease (COPD), reduced lung function and an increased risk of Alzheimer’s disease. However, it remains unclear if these diseases are causally linked, or due to shared risk factors. Conventional observational epidemiology suffers from unmeasured confounding and reverse causation. Additional analyses addressing causality are required. Objectives To examine a causal relationship between COPD, lung function and Alzheimer’s disease. Methods Using two-sample Mendelian randomisation, we used single nucleotide polymorphisms (SNPs) identified in a genome wide association study (GWAS) for lung function as instrumental variables (exposure). Additionally, we used SNPs discovered in a GWAS for COPD in those with moderate to very severe obstruction. The effect of these SNPs on Alzheimer’s disease (outcome) was taken from a GWAS based on a sample of 24 807 patients and 55 058 controls. Results We found minimal evidence for an effect of either lung function (OR: 1.02 per SD; 95% CI 0.91 to 1.13; p value 0.68) or liability for COPD on Alzheimer’s disease (OR: 0.97 per SD; 95% CI 0.92 to 1.03; p value 0.40). Conclusion Neither reduced lung function nor liability COPD are likely to be causally associated with an increased risk of Alzheimer’s, any observed association is likely due to unmeasured confounding. Scientific attention and health prevention policy may be better focused on overlapping risk factors, rather than attempts to reduce risk of Alzheimer’s disease by targeting impaired lung function or COPD directly.
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Affiliation(s)
- Daniel Higbee
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Raquel Granell
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Esther Walton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Department of Psychology, University of Bath, Bath, Somerset, UK
| | | | | | - James Dodd
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK .,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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18
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Souliotis K, Silva Miguel L, Hillas G, Borges M, Papageorgiou G, Viana D, Malhadeiro J, Soulard S. The cost-saving switch from inhaled corticosteroid-containing treatments to dual bronchodilation: a two-country projection of epidemiological and economic burden in chronic obstructive pulmonary disease. Ther Adv Respir Dis 2021; 14:1753466620926802. [PMID: 32519591 PMCID: PMC7288795 DOI: 10.1177/1753466620926802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 recommendations support maintenance treatment with long-acting bronchodilators in most symptomatic patients with chronic obstructive pulmonary disease (COPD). While restricting the overuse of inhaled corticosteroids (ICS) may influence healthcare utilization required to treat inadvertent respiratory (exacerbations and pneumonia) and diabetes-related events, it may also change the total medication cost. This analysis was performed to estimate the 5-year budget impact of switching from ICS-containing treatment combinations to dual bronchodilation, in line with the recommendations. Methods: The model quantified the budget impact of treatment and healthcare resource utilization when COPD patients were anticipated to switch from ICS-containing treatments to dual bronchodilation. Three switch scenarios were calculated with increasing proportions of patients on dual long-acting bronchodilators, to the detriment of ICS-containing double and triple combinations. Clinical and cost input data were based on results from clinical trials and Greek and Portuguese healthcare cost databases. Results: Healthcare resource use to manage exacerbations, pneumonia and diabetes-related events were projected to increase between 2019 and 2023 in parallel with the growing COPD patient population and associated costs were estimated at 52–57% of the total disease cost in the Greek and Portuguese base case scenarios. Total cost savings between 21 and 112 million EUR were projected when the proportion of patients on double and triple ICS-containing treatments was gradually reduced to 50% in scenario A, 20% in scenario B and 7% in scenario C. Sensitivity analyses showed that none of the model assumptions had a major impact on the projected savings. Conclusion: The alignment of COPD treatment with current recommendations may bring clinical benefits to patients, without substantial cost increases and even cost savings for payers. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece.,Health Policy Institute, Athens, Greece
| | - Luís Silva Miguel
- The Centre for Evidence Based Medicine (CEMBE), Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Georgios Hillas
- 5th Pulmonary Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Margarida Borges
- The Centre for Evidence Based Medicine (CEMBE), Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | | | | | - Stéphane Soulard
- Boehringer Ingelheim, De Boelelaan 32, Amsterdam, 1083 HJ, The Netherlands
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19
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Buja A, Bardin A, Grotto G, Elvini S, Gallina P, Zumerle G, Benini P, Scibetta D, Baldo V. How different combinations of comorbidities affect healthcare use by elderly patients with obstructive lung disease. NPJ Prim Care Respir Med 2021; 31:30. [PMID: 34035314 PMCID: PMC8149628 DOI: 10.1038/s41533-021-00242-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Previous research had shown the number of comorbidities is a major factor influencing the burden of care for elderly patients with obstructive lung disease (OLD). This retrospective cohort study on a large population of elderly patients (age > 65 years) with OLD in northern Italy measures the use of healthcare resources associated with the most frequent combinations of comorbidities and investigates the most common reasons for hospitalization. Total health costs, pharmacy costs, emergency department (ED) visits, outpatient visits, and hospital admissions are assessed for every subject. The most common causes of hospitalization by a number of comorbidities and the most common sets of three comorbidities are identified. For each comorbidity group, we rank a list of the most frequent causes of hospitalization, both overall and avoidable with effective ambulatory care. A small group of patients suffering from major comorbidities accounts for the use of most healthcare resources. The most frequent causes of hospitalization are respiratory failure, heart failure, chronic bronchitis, and bronchopneumonia. The most common conditions manageable with ambulatory care among causes of hospitalizations are heart failure, bacterial pneumonia, and COPD. The set of three comorbidities responsible for the highest average total costs, and the highest average number of hospitalizations and outpatient visits comprised hypertension, cardiac arrhythmias, and heart failure. The main reasons for hospitalization proved to remain linked to heart failure and acute respiratory disease, regardless of specific combinations of comorbidities. Based on these findings, specific public health interventions among patients with OLD cannot be advised on the basis of specific sets of comorbidities only.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy.
| | - Andrea Bardin
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Giulia Grotto
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | | | | | | | | | | | - Vincenzo Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
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20
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Kalhan R, Slade D, Ray R, Moretz C, Germain G, Laliberté F, Shen Q, Duh MS, MacKnight SD, Hahn B. Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities. Int J Chron Obstruct Pulmon Dis 2021; 16:1149-1161. [PMID: 33911860 PMCID: PMC8075186 DOI: 10.2147/copd.s298032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background Comorbidities in patients with chronic obstructive pulmonary disease (COPD) are associated with increased medical costs and risk of exacerbations. This study compared COPD-related medical costs and exacerbations in high-cost, high-comorbidity patients with COPD receiving initial maintenance treatment (IMT) with umeclidinium/vilanterol (UMEC/VI) versus fluticasone propionate/salmeterol (FP/SAL), budesonide/formoterol (B/F), or tiotropium (TIO). Methods This retrospective, matched cohort study identified patients from Optum’s de-identified Clinformatics Data Mart database who initiated UMEC/VI, FP/SAL, B/F, or TIO between January 1, 2014 and December 31, 2018 (index date defined as date of the first fill). Eligibility criteria included age ≥40 years at index, ≥1 pre-index COPD diagnosis, no pre-index asthma diagnosis, 12 months of continuous insurance coverage pre-index, and high pre-index costs (≥80th percentile of IMT population) and comorbidities (Quan-Charlson comorbidity index ≥3). Propensity score matching was used to control for potential confounders. On-treatment COPD-related medical costs (primary endpoint) and exacerbations were evaluated. Results Matched cohorts were well balanced on baseline characteristics (UMEC/VI vs FP/SAL: n=1194 each; UMEC/VI vs B/F: n=1441 each; UMEC/VI vs TIO: n=1277 each). Patients receiving UMEC/VI had significantly lower COPD-related medical costs versus FP/SAL (difference: $6587 per patient per year; P=0.048), and numerically lower costs versus B/F and TIO. Patients initiating UMEC/VI had significantly lower risk of COPD-related severe exacerbation versus FP/SAL (hazard ratio [95% CI]: 0.78 [0.62, 0.98]; P=0.032), B/F (0.77 [0.63, 0.95]; P=0.016), and TIO (0.79 [0.64, 0.98]; P=0.028). The rate of COPD-related severe exacerbations was significantly lower with UMEC/VI versus FP/SAL (rate ratio [95% CI]: 0.73 [0.59, 0.91]; P=0.008) and B/F (0.73 [0.59, 0.93]; P=0.012), and numerically lower versus TIO (0.83 [0.68, 1.04]; P=0.080). Conclusion These findings suggest that high-cost, high-comorbidity patients with COPD receiving UMEC/VI compared with FP/SAL, B/F, and TIO as IMT may have lower medical costs and exacerbation risk.
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Affiliation(s)
- Ravi Kalhan
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Slade
- US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Riju Ray
- US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Chad Moretz
- US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Qin Shen
- US Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA
| | | | | | - Beth Hahn
- US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA
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21
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Mao X, Liang C, Niu H, Dong F, Huang K, Chen Y, Huang K, Zhan Q, Zhang Y, Huang Y, Yang T, Wang C. Outcomes associated with comorbid diabetes among patients with COPD exacerbation: findings from the ACURE registry. Respir Res 2021; 22:7. [PMID: 33407433 PMCID: PMC7789818 DOI: 10.1186/s12931-020-01607-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
Background Diabetes is a common comorbidity among patients with exacerbation of chronic obstructive pulmonary disease (AECOPD). Diabetes has been reported to be associated with length of stay (LOS), death, and cost among AECOPD patients. However, most studies are retrospective or have small sample sizes. The association for cost has not been researched using diabetes as a main analytic factor. This study aimed to fill gaps mentioned above, to compare basic characteristics between the diabetic and non-diabetic group, and to detect associations between diabetes and clinical outcomes among patients hospitalized with AECOPD. Methods A total of 5334 AECOPD patients, classified into diabetic and non-diabetic group, were included from a prospective multicenter patient registry study. Generalized linear regression and logistic regression were separately used for the association between diabetes and direct hospitalization cost and the association between diabetes and LOS. Results Generally, diabetic patients had a more severe profile, including being older, more overweight or obese, having more former smokers, more emergency room visits in the past 12 months, and more comorbidities occurrence. Diabetic patients also had worse clinical outcomes, including higher cost and longer LOS. Additionally, the generalized linear regression indicated that the marginal mean cost difference between diabetic and non-diabetic patients was RMB (¥) 775.7. Conclusions AECOPD patients with comorbid diabetes had a more severe profile and higher direct hospitalization cost. Diabetes screening and integrated care programs might help reduce the heavy comorbidity and economic burden. Moreover, corticosteroids and metformin could be considered in the treatment of these patients. Trial registration Clinicaltrials.gov with the identifier NCT0265752.
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Affiliation(s)
- Xihua Mao
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Chen Liang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Fen Dong
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yaowen Zhang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Yin Huang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Respiratory Diseases, Beijing, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Respiratory Diseases, Beijing, China. .,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China. .,Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng, Beijing, 100730, China.
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22
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Buja A, Elvini S, Caberlotto R, Pinato C, Mafrici SF, Grotto G, Bicciato E, Baldovin T, Zumerle G, Gallina P, Baldo V. Healthcare Service Usage and Costs for Elderly Patients with Obstructive Lung Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:3357-3366. [PMID: 33376316 PMCID: PMC7755892 DOI: 10.2147/copd.s275687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background The worldwide prevalence of obstructive lung disease (OLD) is increasing, especially among people >65 years old, and nearly three in four adults with OLD have two or more comorbid conditions. This study describes the impact of such comorbidities on the healthcare service usage and related costs in a country with universal health coverage, basing on a large cohort of elderly patients with OLD and employing real-world data. Methods We carried out a retrospective cohort study on a large population of elderly (age >64 years) patients with OLD served by a Local Health Unit in northern Italy. Their comorbidities were assessed using the clinical diagnoses assigned by the Adjusted Clinical Group (ACG) system to individual patients by combining different information flows. Correlations between number of comorbidities and total annual healthcare service usage and costs were examined with Spearman's test. Regression models were applied to analyze the associations between the above-mentioned variables, adjusting for age and sex. Results All types of healthcare service usage (access to emergency care; number of outpatient visits; number of hospital admissions) and pharmacy costs increased significantly with the number of comorbidities. Average total annual costs increased steadily with the number of comorbidities, ranging from € 1158.84 with no comorbidities up to € 9666.60 with 6 comorbidities or more. Poisson regression analyses showed an independent association between the number of comorbidities and the use of every type of healthcare service. Conclusion These results based on real-world data provide evidence that the burden of care for OLD patients related to their comorbidities is independent of and in addition to the burden related to OLD alone and is strongly dependent on the number of comorbidities, suggesting a holistic approach to multimorbid patients with OLD is the most sound public health strategy.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Stefania Elvini
- Controllo di Gestione, AULSS 6 Euganea, Regione Veneto, Padova, Italy
| | - Riccardo Caberlotto
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Carlo Pinato
- Department of Cardiologic, Vascular, and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Simona Fortunata Mafrici
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Giulia Grotto
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Enrica Bicciato
- School of Specialization in Hygiene, Preventive Medicine and Public Health, University of Padua, Padova, Italy
| | - Tatjana Baldovin
- Department of Cardiologic, Vascular, and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
| | - Giulia Zumerle
- Controllo di Gestione, AULSS 6 Euganea, Regione Veneto, Padova, Italy
| | - Pietro Gallina
- Direzione Sanitaria, AULSS 6 Euganea, Regione Veneto, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences, and Public Health, University of Padua, Padova, Italy
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Ding R, Zhu D, Ma Y, Shi X, He P. Comparison of health service use and costs in stroke with and without comorbidities: a cross-sectional analysis using China urban medical claims data. BMJ Open 2020; 10:e037032. [PMID: 33303430 PMCID: PMC7733184 DOI: 10.1136/bmjopen-2020-037032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Stroke is the leading cause of death and disability in China, but there is scare of evidence on whether and to what extent comorbidity affects the stroke-related costs in health system. We examined the association between comorbidity and stroke-related health service utilisation and costs in urban China. SETTINGS The data used in this study were extracted by a 5% random sampling from claims data of China Urban Employees' Basic Medical Insurance and Urban Residents' Basic Medical Insurance from 2013 to 2016, which covered more than 93% of residents in urban China. The data included 89 cities and contained beneficiaries' demographic information, medical diagnoses and expenditures of outpatient and inpatients services. PARTICIPANTS 382 906 patients with stroke were identified as the study population in this study. PRIMARY AND SECONDARY OUTCOME MEASURES The information on health service utilisation and cost was extracted based on the condition that stroke was claimed as the index disease. RESULTS Among 382 906 patients with stroke, 41.0% had a comorbidity. The estimated number of annual outpatient visits among patients with 0, 1, 2 and 3 or more comorbidities were 1.97, 2.30, 2.34 and 2.37, respectively. The annual outpatient expenditure increased from 762.4 (95% CI 746.9 to 777.8) RMB among patients without any comorbidities to 1156.4 (1132.7 to 1180.2) RMB among patients with three or more comorbidities. The increased utilisation and costs among patients with comorbidity were also observed for inpatient services. Stroke-related services utilisation and costs were significantly increased among patients who comorbid conditions like hypertension or chronic pulmonary diseases. CONCLUSION Comorbidity among patients with stroke was associated with increased healthcare utilisation and cost. It poses an extra substantial healthcare burden in China. Our study provides information for both clinical management and health service planning and financing for patients with stroke.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yong Ma
- China Health Insurance Research Association, Beijing, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Omori H, Higashi N, Nawa T, Fukui T, Kaise T, Suzuki T. Associated Factors and Comorbidities of Airflow Limitation in Subjects Undergoing Comprehensive Health Examination in Japan - Survey of Chronic Obstructive Pulmonary Disease Patients Epidemiology in Japan (SCOPE- J). Int J Chron Obstruct Pulmon Dis 2020; 15:3039-3050. [PMID: 33262583 PMCID: PMC7696619 DOI: 10.2147/copd.s272588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify associated factors of having at least one of the airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases in health examinees, and to describe the characteristics of each subgroup classified by comorbidities. Subjects and Methods This was an observational cross-sectional survey carried out in multiple regions of Japan. Subjects aged 40 years older, undergoing comprehensive health examination, were recruited. Airflow limitation was defined as having forced expiratory volume in 1 s/forced vital capacity lower than 70%. Associated factors of having at least one of the airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases were examined by logistic regression analysis. Subgroup classification by comorbidity patterns was conducted by hierarchical cluster analysis. Results In a total of 22,293 subjects, 1520 (6.8%) had at least one of the airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases. With this objective variable, the following explanatory variables were significantly associated: older age, higher total score in the chronic obstructive pulmonary disease assessment test (CAT) and coexistence of lung cancer (common in ever-smokers and never-smokers), higher pack-years, lower body mass index, higher C-reactive protein, without coexistence of diabetes mellitus (specific in ever-smokers), male sex, coexistence of anxiety, and sleep disorder (specific in never-smokers). Among the 1520 subjects, 1512 subjects with smoking history data were classified by comorbidity patterns into subgroups of "no comorbidities," "mixed comorbidities," "inflammatory comorbidities," "overweight," "underweight," and "chronic kidney disease." "Inflammatory comorbidities" were specific in ever-smokers, and "underweight" was specific in never-smokers. Conclusion Several factors were identified as associated factors of having at least one of airflow limitation, chronic cough/phlegm, and currently treated respiratory diseases and they were different between ever-smokers and never-smokers. Different comorbidity patterns were observed by smoking history. These findings could provide information to assist the management of subjects with COPD or at risk for COPD in the general population.
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Affiliation(s)
- Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Noritaka Higashi
- Department of Respiratory Medicine, Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
| | | | - Toshiki Fukui
- Center for Preventive Medical Treatment, Olive Takamatsu Medical Clinic, Takamatsu, Japan
| | - Toshihiko Kaise
- Japan Development Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Takeo Suzuki
- Japan Development Division, GlaxoSmithKline K.K., Tokyo, Japan
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25
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Hong YD, Onukwugha E, Slejko JF. The Economic Burden of Comorbid Obstructive Sleep Apnea Among Patients with Chronic Obstructive Pulmonary Disease. J Manag Care Spec Pharm 2020; 26:1353-1362. [PMID: 32996389 PMCID: PMC10391088 DOI: 10.18553/jmcp.2020.26.10.1353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on patients and the health care system. The presence of comorbid obstructive sleep apnea (OSA) has been shown to increase the risk of morbidity and mortality in patients with COPD. There is limited information available on the incremental economic burden of comorbid OSA among patients with COPD. OBJECTIVE To estimate the incremental health care resource utilization (HCRU) and direct medical costs associated with having comorbid OSA among individuals with COPD in a nationally representative commercially insured population in the United States. METHODS We identified individuals with a diagnosis of COPD between January 2008 and December 2014, with and without OSA, from the IQVIA PharMetrics Plus database. The index date was defined as the first claim with a diagnosis of COPD. All baseline characteristics were measured in the 12-month pre-index period, and all outcomes were measured in the 12-month post-index period. The odds of experiencing one or more hospitalizations and emergency room (ER) visits were compared between individuals with and without comorbid OSA using logistic regression models. Twelve-month total, physician office visit, and other outpatient costs were compared between individuals with and without OSA using generalized linear models. To account for a high proportion of zero costs, 2-part models were fit to examine inpatient, ER visit, and pharmacy costs. Average marginal costs were estimated to compare the costs of individuals with and without OSA. All costs represented direct medical costs from the health plan perspective. RESULTS Following application of inclusion and exclusion criteria, the study sample included 85,940 individuals with COPD alone and 7,942 individuals with COPD and OSA. The odds of experiencing a hospitalization and an ER visit were significantly higher in the COPD-OSA cohort than in the COPD-only cohort (hospitalization OR = 1.45, 95% CI = 13531.38-1.53; ER visit OR = 1.24, 95% CI = 1.18-1.30). The average difference in total cost between individuals with and without comorbid OSA was $8,144 (95% CI = $7,295-$8,993). The average difference in costs for physician office visits and other outpatient services was $392 (95% CI = $351-$433) and $2,831 (95% CI = $2,463-$3,200), respectively. Among individuals with a non-zero, strictly positive inpatient cost, the average difference in inpatient costs was $2,792 (95% CI = $1,354-$4,230). Similarly, among individuals with strictly positive pharmacy and ER costs, the average difference in costs between individuals with and without comorbid OSA was $1,772 (95% CI = $1,590-$1,953) and $144 (95% CI = $101-$188), respectively. CONCLUSIONS Total medical cost and costs for inpatient, ER, pharmacy, physician office visit, and other outpatient services were higher among COPD patients with comorbid OSA compared to patients without. The economic burden of comorbid OSA among patients with COPD in the commercially insured U.S. population is substantial. DISCLOSURES No outside funding supported this study. Onukwugha reports grants from Bayer Healthcare Pharmaceuticals and Pfizer, unrelated to this work. Slejko reports grants from PhRMA, the PhRMA Foundation, Novartis Pharmaceuticals, and Takeda Pharmaceuticals, along with a teaching honorarium from Pfizer, unrelated to this work. Hong has nothing to disclose.
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Affiliation(s)
- Yoon Duk Hong
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Julia F. Slejko
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
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The COPD-readmission (CORE) score: A novel prediction model for one-year chronic obstructive pulmonary disease readmissions. J Formos Med Assoc 2020; 120:1005-1013. [PMID: 32928614 DOI: 10.1016/j.jfma.2020.08.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (COPD) results in deterioration of lung function and mortality. Previous prediction models have been designed for severe exacerbation of COPD, leading to readmission. However, these models lacked newly established predictors such as the eosinophil count. The present study developed a novel CO PD-re admission (CORE) score. METHODS We retrospectively reviewed medical records of patients visiting Taipei Tzu Chi Hospital between January 1, 2014, and May 31, 2017. We analyzed all covariates by univariate and then multivariate logistic regressions. Numeric or ordinal variables showing statistical significance were transformed into dichotomous variables by cut-off values determined by the Youden Index. The CORE score was designed to predict one-year readmission rates. RESULTS A total of 625 patients were recruited. After analysis, the CORE score included five predictors (eosinophil count, lung function, triple inhaler therapy, previous hospitalization, and neuromuscular disease). We observed a highly linear relationship between the CORE score and COPD readmission (R = 0.981; R 2 = 0.963; P < 0.001). The CORE score had a higher predictive accuracy than that for hospitalization in the previous year (area under the curve = 0.703 vs. 0.619; P < 0.001). Patients with higher CORE scores had a shorter time to first COPD readmission (P < 0.001). Using the zero point as a reference, the hazard ratios for each score from 1 to 4 were 1.209, 2.211, 3.359, and 4.510, respectively. CONCLUSION The CORE score includes two novel predictors (eosinophil count and triple inhaler therapy). The model has a high predictive power for one-year COPD readmission.
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Burden of Healthcare Utilization among Chronic Obstructive Pulmonary Disease Patients with and without Cancer Receiving Palliative Care: A Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144980. [PMID: 32664347 PMCID: PMC7400487 DOI: 10.3390/ijerph17144980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 01/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic disease that burdens patients worldwide. This study aims to discover the burdens of health services among COPD patients who received palliative care (PC). Study subjects were identified as COPD patients with ICU and PC records between 2009 and 2013 in Taiwan's National Health Insurance Research Database. The burdens of healthcare utilization were analyzed using logistic regression to estimate the difference between those with and without cancer. Of all 1215 COPD patients receiving PC, patients without cancer were older and had more comorbidities, higher rates of ICU admissions, and longer ICU stays than those with cancer. COPD patients with cancer received significantly more blood transfusions (Odds Ratio, OR: 1.66; 95% C.I.: 1.11-2.49) and computed tomography scans (OR: 1.88; 95% C.I.: 1.10-3.22) compared with those without cancer. Bronchoscopic interventions (OR: 0.26; 95% C.I.: 0.07-0.97) and inpatient physical restraints (OR: 0.24; 95% C.I.: 0.08-0.72) were significantly more utilized in patients without cancer. COPD patients without cancer appeared to receive more invasive healthcare interventions than those without cancer. The unmet needs and preferences of patients in the life-limiting stage should be taken into consideration for the quality of care in the ICU environment.
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Ding R, Zhu D, He P, Ma Y, Chen Z, Shi X. Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China. BMC Cancer 2020; 20:250. [PMID: 32209058 PMCID: PMC7092481 DOI: 10.1186/s12885-020-06759-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background It is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China. Methods We used claims data from China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively. Results Among 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941.9), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI:1.012–1.441) and chemotherapy (1.363, 1.196–1.554), and decreased possibility of choosing surgery (0.850, 0.730–0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions. Conclusion Comorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.
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Affiliation(s)
- Ruoxi Ding
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ping He
- China Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Yong Ma
- China Health Insurance Research Association, Beijing, 100013, China
| | - Zhishui Chen
- Department of Medical Insurance, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
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Axson EL, Ragutheeswaran K, Sundaram V, Bloom CI, Bottle A, Cowie MR, Quint JK. Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis. Respir Res 2020; 21:54. [PMID: 32059680 PMCID: PMC7023777 DOI: 10.1186/s12931-020-1312-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/04/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Discrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients. METHODS MEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR). RESULTS Twenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF. CONCLUSIONS In this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF comorbidity may differ depending on COPD phenotype, HF type, or HF severity and should be the topic of future research.
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Affiliation(s)
- Eleanor L Axson
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK.
| | - Kishan Ragutheeswaran
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Varun Sundaram
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Alex Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
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Lin SY, Xue H, Deng Y, Chukmaitov A. Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk. Int J Chron Obstruct Pulmon Dis 2020; 15:143-154. [PMID: 32021153 PMCID: PMC6970247 DOI: 10.2147/copd.s230072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022] Open
Abstract
Background and Objective Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. COPD is expensive to treat, whereas the quality of care is difficult to evaluate due to the high prevalence of multi-morbidity among COPD patients. In the US, the Hospital Readmissions Reduction Program (HRRP) was initiated by the Centers for Medicare and Medicaid Services to penalize hospitals for excessive 30-day readmission rates for six diseases, including COPD. This study examines the difference in 30-day readmission risk between COPD patients with and without comorbidities. Methods In this retrospective cohort study, we used Cox regression to estimate the hazard ratio of 30-day readmission rates for COPD patients who had no comorbidity and those who had one, two or three, or four or more comorbidities. We controlled for individual, hospital and geographic factors. Data came from three sources: Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Area Health Resources Files (AHRF) and the American Hospital Association’s (AHA's) annual survey database for the year of 2013. Results COPD patients with comorbidities were less likely to be readmitted within 30 days relative to patients without comorbidities (aHR from 0.84 to 0.87, p < 0.05). In a stratified analysis, female patients with one comorbidity had a lower risk of 30-day readmission compared to female patients without comorbidity (aHR = 0.80, p < 0.05). Patients with public insurance who had comorbidities were less likely to be readmitted within 30 days in comparison with those who had no comorbidity (aHR from 0.79 to 0.84, p < 0.05). Conclusion COPD patients with comorbidities had a lower risk of 30-day readmission compared with patients without comorbidity. Future research could use a different study design to identify the effectiveness of the HRRP.
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Affiliation(s)
- Shuo-Yu Lin
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Hong Xue
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Yangyang Deng
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Askar Chukmaitov
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD. J Clin Med 2019; 8:jcm8091460. [PMID: 31540306 PMCID: PMC6780973 DOI: 10.3390/jcm8091460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/23/2023] Open
Abstract
Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.
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Insights about the economic impact of chronic obstructive pulmonary disease readmissions post implementation of the hospital readmission reduction program. Curr Opin Pulm Med 2019; 24:138-146. [PMID: 29210750 DOI: 10.1097/mcp.0000000000000454] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) affects over 12 million adults in the United States and is the third leading cause of 30-day readmissions. COPD is costly with almost $50 billion in direct costs annually. Total COPD costs can be up to double the identified direct costs because of comorbid disease and numerous indirect costs such as absenteeism. Acute exacerbations of COPD (AECOPD) are responsible for up to 70% of COPD-related healthcare costs; hospital readmissions alone account for over $15 billion annually. In this review, we aim to describe insights about the economic impact of COPD readmissions based on articles published over the last 18 months. RECENT FINDINGS Interventions aimed at reducing readmission, particularly those using interdisciplinary teams with bundled care interventions, were uniformly successful at improving the quality of care provided and demonstrating improved process measures. However, success at reducing readmissions and cost savings based on these interventions varied across the studies. SUMMARY The literature to date points to factors and conditions that may place patients at higher risk of readmissions and may lead to higher costs. Interventions aimed at reducing readmissions after index admissions for AECOPD have demonstrated variable results. Most interventions did not reflect cost-based analyses.
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Wittbrodt ET, Millette LA, Evans KA, Bonafede M, Tkacz J, Ferguson GT. Differences in health care outcomes between postdischarge COPD patients treated with inhaled corticosteroid/long-acting β 2-agonist via dry-powder inhalers and pressurized metered-dose inhalers. Int J Chron Obstruct Pulmon Dis 2019; 14:101-114. [PMID: 30613140 PMCID: PMC6307496 DOI: 10.2147/copd.s177213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose The aim of this study was to examine real-world differences in health care resource use (HRU) and costs among COPD patients in the USA treated with a dry powder inhaler (DPI) or pressurized metered-dose inhaler (pMDI) following a COPD-related hospitalization. Methods This retrospective analysis used the Truven MarketScan® databases. Eligibility criteria included 1) age ≥40 years, 2) COPD diagnosis, 3) inpatient admission with a diagnosis of COPD exacerbation, 4) inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) prescription within 10 days of hospital discharge (index date), and 5) continuous enrollment for 12 months preindex and 90 days postindex. Outcomes included pre- and postindex HRU and costs. DPI and pMDI groups were compared on postindex outcomes via multivariate models controlling for demographic and baseline characteristics. Results The sample included 1,960 DPI and 1,086 pMDI ICS/LABA patients. During the preindex period, pMDI patients were significantly more likely to be prescribed a short-acting β-agonist, experienced more COPD exacerbation-related hospital days, and had a greater number of pulmonologist visits compared to DPI patients (P<0.05), all suggestive of greater disease severity. However, multivariate models revealed that pMDI patients incurred 10% lower all-cause postindex costs (predicted mean costs [2016 US dollars]: $2,673 vs $2,956) and 19% lower COPD-related costs (predicted mean costs: $138 vs $169; P<0.05). Additionally, pMDI patients were 28% less likely to experience a COPD exacerbation-related hospital readmission within 60 days postdischarge compared to the DPI patients (OR: 0.72, 95% CI: 0.52–0.99, P<0.05). Conclusion Despite greater COPD-related HRU and costs preceding index hospitalization, US patients using a pMDI after hospital discharge incurred significantly lower all-cause and COPD-related health care costs compared with those using a DPI, in addition to a decreased likelihood of a COPD exacerbation-related hospital readmission. Results suggest that inhaler device type may influence COPD outcomes and that COPD patients may derive greater clinical benefit from treatment delivered via pMDI vs DPI.
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Affiliation(s)
| | | | - Kristin A Evans
- Life Sciences, Value-Based Care, IBM Watson Health, Cambridge, MA, USA
| | - Machaon Bonafede
- Life Sciences, Value-Based Care, IBM Watson Health, Cambridge, MA, USA
| | - Joseph Tkacz
- Life Sciences, Value-Based Care, IBM Watson Health, Cambridge, MA, USA
| | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
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Graumam RQ, Pinheiro MM, Nery LE, Castro CHM. Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity. Osteoporos Int 2018; 29:1457-1468. [PMID: 29564475 DOI: 10.1007/s00198-018-4483-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/07/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED A very high rate of osteoporosis, fractures, and low lean mass was observed in patients with chronic obstructive pulmonary disease (COPD). Disease severity was associated with bone and muscle adverse outcomes, while age ≥ 63.5 years old, low lean mass, higher iPTH, and a T-score below - 2.5 were all associated with higher risk of fracture. INTRODUCTION Osteoporosis is frequently neglected in patients with COPD. We aimed at evaluating the rate of osteoporosis, fractures, and low lean mass in patients with COPD. METHODS Ninety-nine patients with COPD (53 women, 64.5 ± 9.6 years old, and 46 men, 65.9 ± 8.0 years old) underwent bone densitometry (DXA) with body composition analyses. Healthy individuals (N = 57) not exposed to tobacco matched by sex, age, and body mass index (BMI) were used as controls. Spirometry, routine laboratory workout, and conventional thoracolumbar radiography surveying for vertebral deformities were performed in all patients. RESULTS Osteoporosis was found in 40.4% of the COPD patients against only 13.0% of the healthy controls (p = 0.001). Vertebral fractures were seen in 24.4% of the men and 22.0% of the women with COPD. Disease severity (GOLD 3 and 4) was significantly associated with higher risk of vitamin D deficiency (p = 0.032), lower BMD (both men and women at all sites), higher frequency of osteoporosis (in women at all sites), lower skeletal mass index, and higher rate of low lean mass (in both men and women) than healthy controls and COPD patients with milder disease (GOLD 1 and 2). Age was a main predictor of vertebral fractures (OR = 1.164 (1.078-9.297); p < 0.001), while high plasma iPTH (OR = 1.045 (1.005-1.088); p = 0.029) and low ALM (OR = 0.99965 (0.99933-0.99997); p = 0.031) were predictors of non-vertebral fractures. CONCLUSION Highly prevalent in COPD, osteoporosis and low lean mass were associated with FEV1% < 50%. Age, low lean mass, high iPTH, and low bone mass were all significantly associated with fractures in COPD patients.
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Affiliation(s)
- R Q Graumam
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - M M Pinheiro
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - L E Nery
- Pulmonology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - C H M Castro
- Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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Wshah A, Guilcher SJ, Goldstein R, Brooks D. Prevalence of osteoarthritis in individuals with COPD: a systematic review. Int J Chron Obstruct Pulmon Dis 2018; 13:1207-1216. [PMID: 29713154 PMCID: PMC5909783 DOI: 10.2147/copd.s158614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The objective of this review was to examine the prevalence of osteoarthritis (OA) in individuals with COPD. A computer-based literature search of CINAHL, Medline, PsycINFO and Embase databases was performed. Studies reporting the prevalence of OA among a cohort of individuals with COPD were included. The sample size varied across the studies from 27 to 52,643 with a total number of 101,399 individuals with COPD recruited from different countries. The mean age ranged from 59 to 76 years. The prevalence rates of OA among individuals with COPD were calculated as weighted means. A total of 14 studies met the inclusion criteria with a prevalence ranging from 12% to 74% and an overall weighted mean of 35.5%. Our findings suggest that the prevalence of OA is high among individuals with COPD and should be considered when developing and applying interventions in this population.
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Affiliation(s)
- Adnan Wshah
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Sara Jt Guilcher
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Jiang X, Xiao H, Segal R, Mobley WC, Park H. Trends in Readmission Rates, Hospital Charges, and Mortality for Patients With Chronic Obstructive Pulmonary Disease (COPD) in Florida From 2009 to 2014. Clin Ther 2018; 40:613-626.e1. [PMID: 29609879 DOI: 10.1016/j.clinthera.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/23/2018] [Accepted: 03/11/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a leading and costly cause of readmissions to the hospital, with one of the highest rates reported in Florida. From 2009 to 2014, strategies such as readmission reduction programs, as well as updated guidelines for COPD management, were instituted to reduce readmission rates for patients with COPD. Thus, the question has been raised whether COPD-related 30-day hospital readmission rates in Florida have decreased and whether COPD-related readmission costs during this period have changed. In addition, we examined trends in length of stay, hospital charges, and in-hospital mortality associated with COPD, as well as identified patient-level risk factors associated with 30-day readmissions. METHODS A retrospective analysis of adult patients (≥18 years of age) with COPD was conducted by using the Healthcare Cost and Utilization Project Florida State Inpatient Database, 2009 to 2014. Weighted least squares regression was used to assess trends in the COPD readmission rate on a yearly basis, as well as other outcomes of interest. A multivariable logistic regression was used to identify patient characteristics that were associated with 30-day COPD readmissions. FINDINGS Overall, 268,084 adults were identified as having COPD. Between 2009 and 2014, more than half of patients aged 65-84 years, most were white, 55% were female, and 73% had Medicare. The unadjusted rate for COPD-related 30-day readmissions did not change (8.04% to 7.85%; P = 0.434). However, the mean total charge for 30-day COPD-related readmissions was significantly higher in 2014 ($40,611) compared with that in 2009 ($36,714) (P = 0.011). The overall unadjusted in-hospital mortality of COPD-related hospitalizations significantly decreased from 1.83% in 2009 to 1.34% in 2014 (P < 0.001). In a multivariable logistic regression model, patients with COPD were 2% less likely to be readmitted to the hospital for each additional year (odds ratio [OR], 0.98 [95% confidence interval (CI), 0.97-0.99]). Factors associated with significantly higher odds of COPD-related readmission were: older age (45 ≤ age ≤ 64 years; OR, 1.91 [95% CI, 1.70-2.14]), being male (OR, 1.14 [95% CI, 1.10-1.17]), and being a Medicaid beneficiary (OR, 1.28 [95% CI, 1.21-1.35]). IMPLICATIONS Although the adjusted odds of COPD readmissions slightly decreased, as did the length of stay and all-cause in-patient mortality, the financial burden increased substantially. Future strategies to further reduce readmissions of patients with COPD and curb financial burden in Florida are needed.
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Affiliation(s)
- Xinyi Jiang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Hong Xiao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - William Cary Mobley
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida.
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Rose L, Istanboulian L, Carriere L, Thomas A, Lee HB, Rezaie S, Shafai R, Fraser I. Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): a randomised controlled trial. Eur Respir J 2018; 51:51/1/1701567. [DOI: 10.1183/13993003.01567-2017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/08/2017] [Indexed: 11/05/2022]
Abstract
We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63–0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54–0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32–0.95). No differences were detected in other secondary outcomes.Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control.
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Lisspers K, Larsson K, Johansson G, Janson C, Costa-Scharplatz M, Gruenberger JB, Uhde M, Jorgensen L, Gutzwiller FS, Ställberg B. Economic burden of COPD in a Swedish cohort: the ARCTIC study. Int J Chron Obstruct Pulmon Dis 2018; 13:275-285. [PMID: 29391785 PMCID: PMC5769573 DOI: 10.2147/copd.s149633] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting. Patients and methods Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed. Results A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179) versus the reference population (€2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient) were the largest economic burden in COPD patients of working age during 2013. Conclusion As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.
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Affiliation(s)
- Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
| | - Kjell Larsson
- Department of Work Environment Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Solna
| | - Gunnar Johansson
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala
| | | | | | | | | | | | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
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Wacker ME, Kitzing K, Jörres RA, Leidl R, Schulz H, Karrasch S, Karch A, Koch A, Vogelmeier CF, Holle R. The contribution of symptoms and comorbidities to the economic impact of COPD: an analysis of the German COSYCONET cohort. Int J Chron Obstruct Pulmon Dis 2017; 12:3437-3448. [PMID: 29270005 PMCID: PMC5720349 DOI: 10.2147/copd.s141852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Although patients with COPD often have various comorbidities and symptoms, limited data are available on the contribution of these aspects to health care costs. This study analyzes the association of frequent comorbidities and common symptoms with the annual direct and indirect costs of patients with COPD. Methods Self-reported information on 33 potential comorbidities and symptoms (dyspnea, cough, and sputum) of 2,139 participants from the baseline examination of the German COPD cohort COSYCONET was used. Direct and indirect costs were calculated based on self-reported health care utilization, work absence, and retirement. The association of comorbidities, symptoms, and COPD stage with annual direct/indirect costs was assessed by generalized linear regression models. Additional models analyzed possible interactions between COPD stage, the number of comorbidities, and dyspnea. Results Unadjusted mean annual direct costs were €7,263 per patient. Other than COPD stage, a high level of dyspnea showed the strongest driving effect on direct costs (+33%). Among the comorbidities, osteoporosis (+38%), psychiatric disorders (+36%), heart disease (+25%), cancer (+24%), and sleep apnea (+21%) were associated with the largest increase in direct costs (p<0.01). A sub-additive interaction between advanced COPD stage and a high number of comorbidities reduced the independent cost-driving effects of these factors. For indirect costs, besides dyspnea (+34%), only psychiatric disorders (+32%) and age (+62% per 10 years) were identified as significant drivers of costs (p<0.04). In the subsequent interaction analysis, a high number of comorbidities was found to be a more crucial factor for increased indirect costs than single comorbidities. Conclusion Detailed knowledge about comorbidities in COPD is useful not only for clinical purposes but also to identify relevant cost factors and their interactions and to establish a ranking of major cost drivers. This could help in focusing therapeutic efforts on both clinically and economically important comorbidities in COPD.
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Affiliation(s)
- Margarethe E Wacker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg
| | - Katharina Kitzing
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg.,Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), LMU Munich
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg.,Institute of Health Economics and Health Care Management, Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich
| | - Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine.,Institute of Epidemiology I, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School, Hannover
| | - Armin Koch
- Institute for Biostatistics, Hannover Medical School, Hannover
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Neuherberg
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Di Marco F, Santus P, Terraneo S, Peruzzi E, Muscianisi E, Ripellino C, Pegoraro V. Characteristics of newly diagnosed COPD patients treated with triple inhaled therapy by general practitioners: a real world Italian study. NPJ Prim Care Respir Med 2017; 27:51. [PMID: 28883469 PMCID: PMC5589801 DOI: 10.1038/s41533-017-0051-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 06/15/2017] [Accepted: 07/24/2017] [Indexed: 12/02/2022] Open
Abstract
Factors predicting prescriptions of triple therapy were investigated in a large group of general practitioners in Italy. In the population treated by identified general practitioners, a cohort of newly diagnosed chronic obstructive pulmonary disease patients was extracted from IMS Health Longitudinal Database during the period 2010-2013. From the diagnosis, 1-year follow-up was evaluated. Thirty-two thousand forty-six newly diagnosed chronic obstructive pulmonary disease patients were evaluated (57.7% male, mean age 67 years). During 2 years prior to diagnosis less than 13% of patients were requested with a pulmonology evaluation and less than 5% with a spirometry; 65.1% cases were prescribed with a respiratory drug, which in 9.6% of cases was inhaled corticosteroid/long-acting β2-agonist fixed-dose combination. Two thousand and twenty eight patients (6.3% of the newly diagnosed chronic obstructive pulmonary disease patients) were treated with triple therapy during the first year of follow-up, whose 858 (42.3%) starting immediately, and 762 (37.6%) following an initial treatment with inhaled corticosteroid/long-acting β2-agonist fixed-dose combination. Being older, being requested with pulmonologist evaluation or spirometry, being prescribed with a inhaled corticosteroid/long-acting β2-agonist fixed-dose combination at diagnosis resulted independent predictors of triple therapy use. CHRONIC LUNG DISEASE ENSURING CORRECT PRESCRIPTIONS FOR EARLY-STAGE DISEASE: An improved education program for doctors promoting correct use of medication for chronic lung disease is needed in Italy. Current guidelines state that inhaled corticosteroids (ICSs) should be reserved for patients with severe chronic obstructive pulmonary disease (COPD), but it appears that doctors do not always follow this advice. Fabiano Di Marco, at San Paolo Hospital-Università degli Studi di Milano, and co-workers analyzed data from 32,046 COPD patients newly-diagnosed by family doctors in Italy between 2010 and 2013. When the researchers followed up on patients after 1 year, 2028 (6.3%) of newly-diagnosed patients were being treated with triple inhaled therapy incorporating ICSs-42% of these patients had started triple therapy immediately upon diagnosis. Being an older male and having been prescribed with a ICS/LABA FDC at diagnosis were strong predictors of triple therapy use within 1 year from the diagnosis.
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Affiliation(s)
- Fabiano Di Marco
- Department of Medical Sciences, Università degli Studi di Milano. Respiratory Unit, San Paolo Hospital, Milan, Italy
| | - Pierachille Santus
- Department of Medical Sciences, Università degli Studi di Milano. Pulmonary Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan-IRCCS, Milan, Italy
| | - Silvia Terraneo
- Department of Medical Sciences, Università degli Studi di Milano. Respiratory Unit, San Paolo Hospital, Milan, Italy
| | - Elena Peruzzi
- Epidemiology and Outcome Research Manager, Novartis Italia, Origgio, VA, Italy
| | - Elisa Muscianisi
- Medical Franchise Leader Respiratory, Novartis Italia, Origgio, VA, Italy
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