Real-World Evidence on Healthcare Resource Utilization (HCRU) and Economic Burden of Patients With COPD Treated With Dual or Triple Therapy: Stratified Analysis by Blood Eosinophil Count and Exacerbation Phenotype in the BREATHE-IN Study
Author(s)
Jaime Espin, MSc, PhD1, Bernardino Alcázar-Navarrete, MD2, Claudia Dias, MSc3, Myriam Calle Rubio, MD4, Montse García Victoria, MD3, José Luis López-Campos, MD5, Emilio Monte-Boquet, PhD6, Paloma I. Palomo-Jiménez, PhD3, Patricia Sobradillo Ecenarro, MD7, Juan J. Soler Cataluña, MD8, Marc Miravitlles, MD9.
1Andalusian School of Public Health, EASP, Granada, Spain, 2Pulmonology Department, Hospital Virgen de las Nieves, Granada, Spain, 3SANOFI, Madrid, Spain, 4Pulmonology Department, Department, Hospital Clínico San Carlos, Madrid, Spain, Madrid, Spain, 5Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain, 6Pharmacy Department, Hospital Universitari i Politècnic la Fe, Valencia, Spain, 7Pulmonology Department, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain, 8Pulmonology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain, 9Pulmonology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
1Andalusian School of Public Health, EASP, Granada, Spain, 2Pulmonology Department, Hospital Virgen de las Nieves, Granada, Spain, 3SANOFI, Madrid, Spain, 4Pulmonology Department, Department, Hospital Clínico San Carlos, Madrid, Spain, Madrid, Spain, 5Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain, 6Pharmacy Department, Hospital Universitari i Politècnic la Fe, Valencia, Spain, 7Pulmonology Department, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain, 8Pulmonology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain, 9Pulmonology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
OBJECTIVES: To evaluate HCRU and direct costs in patients with COPD, stratified by treatment regimen (dual vs triple therapy), blood eosinophil (EoS) count, and exacerbation status (exacerbators [EX] vs non-exacerbators [NEX]).
METHODS: This retrospective observational cohort study used the BIG-PAC® database, including Spanish patients aged ≥40 years diagnosed with COPD and receiving ≥3 months of dual (DT: LABA+LAMA) or triple therapy (TT: LABA+LAMA+ICS) as of January 1, 2023. Patients were classified by baseline EoS count (<100, 100-299, ≥300, ≥500 cells/μL) and exacerbation phenotype. HCRU and direct costs (medical visits, diagnostics, hospitalisations, pharmacotherapy) were analysed over 12-month follow-up using national cost references.
RESULTS: A total of 20,295 patients were analysed (53.0% DT, 47.0% TT). Mean (SD) age was 72.6 (9.6) years. Males represented 70.4%. EX accounted for 20.3% of patients; 58.5% received TT. TT patients had consistently higher resource use, especially among EX and those with elevated EoS. EX-TT patients had a mean (SD) of 10.00 (5.28) primary care visits, 2.83 (3.58) pulmonology visits, and 2.71 (1.66) emergency visits versus 6.34 (4.46), 1.04 (1.69), and 0.36 (0.59), respectively, in NEX-DT. Overall, hospitalisation rates were higher in EX vs NEX (66.5% vs 35.7%), with longer stays (11.87 vs 2.83 days) and higher mean costs (€8,516.3 [SD: €9,205.5] vs €2,029.7 [SD: €3,185.2]). Among EX-TT with EoS ≥500, 86% were hospitalized at least once (mean 2.30 [SD: 1.57]; stay: 24.8 days [SD: 16.8]). Mean direct costs were nearly three times higher in EX vs NEX (€17,565.7 [SD: €15,273.9] vs €6,790.5 [SD: €7,457.1]) and increased with EoS. The highest costs were observed in EX-TT with EoS ≥ 500 (€30,437.4 [SD: €20,851.8]).
CONCLUSIONS: In real-world settings, COPD patients with high EoS and EX phenotype have substantially higher HCRU and direct costs, especially when treated with TT. EoS-based stratification may support more cost-effective COPD management.
METHODS: This retrospective observational cohort study used the BIG-PAC® database, including Spanish patients aged ≥40 years diagnosed with COPD and receiving ≥3 months of dual (DT: LABA+LAMA) or triple therapy (TT: LABA+LAMA+ICS) as of January 1, 2023. Patients were classified by baseline EoS count (<100, 100-299, ≥300, ≥500 cells/μL) and exacerbation phenotype. HCRU and direct costs (medical visits, diagnostics, hospitalisations, pharmacotherapy) were analysed over 12-month follow-up using national cost references.
RESULTS: A total of 20,295 patients were analysed (53.0% DT, 47.0% TT). Mean (SD) age was 72.6 (9.6) years. Males represented 70.4%. EX accounted for 20.3% of patients; 58.5% received TT. TT patients had consistently higher resource use, especially among EX and those with elevated EoS. EX-TT patients had a mean (SD) of 10.00 (5.28) primary care visits, 2.83 (3.58) pulmonology visits, and 2.71 (1.66) emergency visits versus 6.34 (4.46), 1.04 (1.69), and 0.36 (0.59), respectively, in NEX-DT. Overall, hospitalisation rates were higher in EX vs NEX (66.5% vs 35.7%), with longer stays (11.87 vs 2.83 days) and higher mean costs (€8,516.3 [SD: €9,205.5] vs €2,029.7 [SD: €3,185.2]). Among EX-TT with EoS ≥500, 86% were hospitalized at least once (mean 2.30 [SD: 1.57]; stay: 24.8 days [SD: 16.8]). Mean direct costs were nearly three times higher in EX vs NEX (€17,565.7 [SD: €15,273.9] vs €6,790.5 [SD: €7,457.1]) and increased with EoS. The highest costs were observed in EX-TT with EoS ≥ 500 (€30,437.4 [SD: €20,851.8]).
CONCLUSIONS: In real-world settings, COPD patients with high EoS and EX phenotype have substantially higher HCRU and direct costs, especially when treated with TT. EoS-based stratification may support more cost-effective COPD management.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE636
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)