Sufferers with continual obstructive pulmonary illness (COPD) are at an elevated danger for pneumonia occasions, which may complicate the administration of their COPD and lead to considerably greater complete well being care useful resource utilization and prices, in line with a poster offered at Digital ISPOR 2021.1
The researchers in contrast Medicare fee-for-service (FFS) sufferers with COPD with pneumonia with those that didn’t expertise pneumonia occasions. Utilizing a CMS-sourced 100% pattern of Medicare FFS sufferers ≥ 40 years with steady enrollment in Medicare Elements A, B, and D between 2015 and 2018, they recognized 381,250 sufferers with COPD with pneumonia and a pair of,075,300 sufferers with COPD with out pneumonia. After 1:1 matching, there have been 322,910 sufferers in every of the cohorts.
Within the unmatched inhabitants, pneumonia sufferers had been older, had extra comorbidities, and extra tobacco dependence. Sufferers with pneumonia made up 15.5% of the overall inhabitants. Within the unmatched inhabitants, 35.7% of sufferers with pneumonia skilled ≥ 1 baseline COPD exacerbations in contrast with 13.2% with out pneumonia.
Within the matched inhabitants, the important thing traits had been nicely balanced between the two cohorts with a slight imbalance within the Charlson Comorbidity Index scores (4.5 within the pneumonia group vs 3.4 within the no pneumonia group).
After matching, well being care useful resource utilization was greater amongst sufferers with pneumonia:
- Hospitalizations had been 65.8% within the pneumonia group vs 35.9% within the no-pneumonia group
- Emergency division visits had been 58.2% within the pneumonia group vs 53.7% within the no-pneumonia group
- Outpatient workplace visits had been 94.0% within the pneumonia group vs 92.3% within the no-pneumonia group
Imply unadjusted well being care expenditures had been additionally greater for sufferers with pneumonia ($53,024) vs sufferers with out pneumonia ($33,874). For sufferers with pneumonia, the associated fee variations was pushed by inpatient hospital prices ($21,228 vs $5888; P < .05). After adjustment, expenditures remained greater ($21,566 vs $14,361).
“The remedy of sufferers with COPD ought to think about the prevalence of pneumonia and the advantages of stopping COPD exacerbations in these with a historical past of pneumonia,” the authors concluded. “Proactive administration methods and selection of COPD remedy ought to appropriately steadiness medical advantages with dangers with a view to decrease potential COPD illness development and healthcare associated prices.”
Triple remedy with inhaled corticosteroid/long-acting muscarinic antagonist/long-acting ß2-agonist is a remedy choice for sufferers with COPD who’ve frequent or extreme exacerbations regardless of upkeep remedy. A poster offered at Digital ISPOR 2021 sought to know the place fixed-dose mixture triple therapies match into medical follow.2 The researchers studied a budesonide/glycopyrrolate/formoterol fumarate (BGF) metered dose inhaler.
The researchers evaluated the price range influence variations by evaluating the present state of affairs with a hypothetical well being plan with a “typical” 1 million member inhabitants. The time horizon of the mannequin was 3 years: yr 1 was the baseline yr that BGF entered the market.
Within the hypothetical well being plan, 59,995 sufferers with reasonable to very extreme COPD had been eligible for BGF in yr 1, and by the third yr, 69,202 had been eligible. The introduction of BGF would avert 1698 reasonable or extreme COPD exacerbations, 15 antagonistic occasions (AEs), and 156 incidents of pneumonia.
The price of COPD medical administration associated to exacerbations, AEs, pneumonia, and rescue remedy would lower by $7.65 million over the three years. The three-year direct price financial savings from including BGF to the formulary could be $1.35 million after accounting for a projected enhance in complete pharmacy prices.
The researchers additionally ran a state of affairs evaluation in for Medicare. They discovered that the overall potential financial savings was $5.81 million over 3 years for a inhabitants of 1 million Medicare sufferers. The financial savings takes into consideration prevented medical occasions, diminished rescue remedy use (–$10.98 million), and internet incurred pharmacy prices ($5.17 million). Considering that many Medicare plans handle solely Half D or Employer Group Waiver Plan sufferers, they found that realized price financial savings was estimated to be $511,633 over 3 years.
In a 3rd state of affairs, they evaluated the complete price offset from switching business sufferers on twin remedy to BGF triple remedy based mostly on the findings from the ETHOS examine. BGF was estimated to keep away from 9569 exacerbations in yr 1 and 31,163 over 3 years in contrast with twin remedy. The triple remedy additionally saved an estimated $212 million in medical price offset financial savings over the three years.
“This mannequin means that utilizing BGF as a remedy choice for COPD might lead to noticeable price range financial savings for each totally insured plans and Medicare plans with Half D–solely sufferers,” the authors wrote.
1. Pollack M, Moretz C, Kumar S, et al. Traits, price and well being care useful resource use in a inhabitants of Medicare fee-for-service (FFS) sufferers with continual obstructive pulmonary illness (COPD) who additionally expertise pneumonia. Offered at: Digital ISPOR 2021; Might 17-20, 2021. Poster PRS7.
2. Erim D, Pollack M, Feigler N. A mannequin for figuring out the price range influence of introducing a brand new single-inhaler triple mixture remedy for managing reasonable to very extreme COPD in america. Offered at: Digital ISPOR 2021; Might 17-20, 2021. Poster PRS6.