AATD Economic Burden: Costs, Comorbidities, and Total Cost of Care

The panel opens "AATD Economic Burden: Costs, Comorbidities, and Total Cost of Care" with a candid look at what claims data can and cannot show.

Dr. Haumschild cites research showing that physician visits and inpatient stays account for most non-drug medical costs in patients with AATD who are not on augmentation therapy. He adds that claims data show nearly twice the rate of COPD-specific ED visits in patients with AATD and COPD compared with COPD alone. He asks Dr. Sandhaus about the burden on patients and health systems.

Dr. Sandhaus welcomes a managed care organization raising the question, noting that the easiest choice for a payer is not to encourage testing. As an author of cost-of-care studies, he cautions that good data are hard to obtain. Many studies identify AATD through an ICD code, yet ordering any AAT test can place that code in the chart. Researchers use workarounds, such as an augmentation prescription plus a diagnosis, or a code appearing three or more times. Some studies are therefore imprecise.

Augmentation therapy adds a cost no usual COPD patient would see, and he expects costs to keep rising as new therapies arrive, including liver-directed treatments. Offsetting that cost are survival differences between treated and untreated patients with lung disease. Untreated patients also have more frequent exacerbations, though reduced ED use has not been shown scientifically.

Dr. Haumschild then asks Dr. Goldklang how comorbidities affect pharmacoeconomic evaluation. Dr. Goldklang says her patients with significant emphysema carry coronary disease, aortic aneurysms, liver risk, and metabolic disease despite augmentation. The Alpha-1 physician often acts as quarterback. Early testing is the only route to earlier treatment, and patients whose only condition is AATD are usually those tested early.

Our next episode, "Plasma-Derived Augmentation Therapy for AATD: Products and Access," moves into the current standard of care, with Dr. Barjaktarevic explaining the four approved products and how they differ.