Health Care Use Among Patients With COPD With Pneumonia and the Cost Savings of Switching to Triple Therapy

Laura Joszt, MA
Laura Joszt, MA

Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.

Two posters presented at Virtual ISPOR 2021 analyzed the health care resource utilization and cost of patients with chronic obstructive pulmonary disease (COPD) with pneumonia, as well as the cost savings of treating patients with frequent or severe COPD exacerbations with a fixed-dose triple therapy.

Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk for pneumonia events, which can complicate the management of their COPD and result in significantly higher total health care resource utilization and costs, according to a poster presented at Virtual ISPOR 2021.1

The researchers compared Medicare fee-for-service (FFS) patients with COPD with pneumonia with those who did not experience pneumonia events. Using a CMS-sourced 100% sample of Medicare FFS patients ≥ 40 years with continuous enrollment in Medicare Parts A, B, and D between 2015 and 2018, they identified 381,250 patients with COPD with pneumonia and 2,075,300 patients with COPD without pneumonia. After 1:1 matching, there were 322,910 patients in each of the cohorts.

In the unmatched population, pneumonia patients were older, had more comorbidities, and more tobacco dependence. Patients with pneumonia made up 15.5% of the total population. In the unmatched population, 35.7% of patients with pneumonia experienced ≥ 1 baseline COPD exacerbations compared with 13.2% without pneumonia.

In the matched population, the key characteristics were well balanced between the 2 cohorts with a slight imbalance in the Charlson Comorbidity Index scores (4.5 in the pneumonia group vs 3.4 in the no pneumonia group).

After matching, health care resource utilization was higher among patients with pneumonia:

  • Hospitalizations were 65.8% in the pneumonia group vs 35.9% in the no-pneumonia group
  • Emergency department visits were 58.2% in the pneumonia group vs 53.7% in the no-pneumonia group
  • Outpatient office visits were 94.0% in the pneumonia group vs 92.3% in the no-pneumonia group

Mean unadjusted health care expenditures were also higher for patients with pneumonia ($53,024) vs patients without pneumonia ($33,874). For patients with pneumonia, the cost differences was driven by inpatient hospital costs ($21,228 vs $5888; P < .05). After adjustment, expenditures remained higher ($21,566 vs $14,361).

“The treatment of patients with COPD should take into consideration the occurrence of pneumonia and the benefits of preventing COPD exacerbations in those with a history of pneumonia,” the authors concluded. “Proactive management strategies and choice of COPD treatment should appropriately balance clinical benefits with risks in order to minimize potential COPD disease progression and healthcare related costs.”

Triple therapy with inhaled corticosteroid/long-acting muscarinic antagonist/long-acting ß2-agonist is a treatment option for patients with COPD who have frequent or severe exacerbations despite maintenance therapy. A poster presented at Virtual ISPOR 2021 sought to understand where fixed-dose combination triple therapies fit into clinical practice.2 The researchers studied a budesonide/glycopyrrolate/formoterol fumarate (BGF) metered dose inhaler.

The researchers evaluated the budget impact differences by comparing the current scenario with a hypothetical health plan with a “typical” 1 million member population. The time horizon of the model was 3 years: year 1 was the baseline year that BGF entered the market.

In the hypothetical health plan, 59,995 patients with moderate to very severe COPD were eligible for BGF in year 1, and by the third year, 69,202 were eligible. The introduction of BGF would avert 1698 moderate or severe COPD exacerbations, 15 adverse events (AEs), and 156 incidents of pneumonia.

The cost of COPD medical management related to exacerbations, AEs, pneumonia, and rescue medication would decrease by $7.65 million over the 3 years. The 3-year direct cost savings from adding BGF to the formulary would be $1.35 million after accounting for a projected increase in total pharmacy costs.

The researchers also ran a scenario analysis in for Medicare. They found that the total potential savings was $5.81 million over 3 years for a population of 1 million Medicare patients. The savings takes into account avoided medical events, reduced rescue medication use (–$10.98 million), and net incurred pharmacy costs ($5.17 million). Taking into account that many Medicare plans manage only Part D or Employer Group Waiver Plan patients, they discovered that realized cost savings was estimated to be $511,633 over 3 years.

In a third scenario, they evaluated the full cost offset from switching commercial patients on dual therapy to BGF triple therapy based on the findings from the ETHOS study. BGF was estimated to avoid 9569 exacerbations in year 1 and 31,163 over 3 years compared with dual therapy. The triple therapy also saved an estimated $212 million in medical cost offset savings over the 3 years.

“This model suggests that using BGF as a treatment option for COPD could result in noticeable budget savings for both fully insured plans and Medicare plans with Part D–only patients,” the authors wrote.

References

1. Pollack M, Moretz C, Kumar S, et al. Characteristics, cost and health care resource use in a population of Medicare fee-for-service (FFS) patients with chronic obstructive pulmonary disease (COPD) who also experience pneumonia. Presented at: Virtual ISPOR 2021; May 17-20, 2021. Poster PRS7.

2. Erim D, Pollack M, Feigler N. A model for determining the budget impact of introducing a new single-inhaler triple combination therapy for managing moderate to very severe COPD in the United States. Presented at: Virtual ISPOR 2021; May 17-20, 2021. Poster PRS6.