Healthcare Pathway of a Large Cohort of Patients With Chronic Obstructive Pulmonary Disease During the Last Year of Life
Author(s)
Michael Mounié, Ph.D.1, Axel Renoux, MSc1, Margaux Lafaurie, Ph.D.1, Agnès Sommet, M.D.-Ph.D.1, Laurent Guilleminault, M.D.-Ph.D.1, Nadège COSTA, Ph.D.2.
1University Hospital Center, Toulouse, France, 2University hospital of Toulouse, Toulouse, France.
1University Hospital Center, Toulouse, France, 2University hospital of Toulouse, Toulouse, France.
OBJECTIVES: The aim of this study is to describe the healthcare pathway during the year prior to death of patients who died from COPD.
METHODS: Patients with COPD between 2017 and 2022 were identified by ICD10 codes: J42 or J43 or J44 in the French National Health Data System. Within this population, patients who died (main cause on death certificate) from COPD or respiratory infection associated with COPD, or from Cardiovascular Disease (CD) between 2017 and 2022 were included in the analysis. Inhaled drug dispensation: short acting bronchodilators (SABA/SAMA), long acting bronchodilators (LABA/LAMA) and corticosteroids (ICS) are the main treatment of the COPD and allow to limit exacerbation risk and symptoms. They were used to describe healthcare pathway within 12 months prior to death. Optimal matching & hierarchical classification methods were used for the analyse of care pathway.
RESULTS: A total of 108,835 patients (67,250 COPD and 41,585 CD), average age 81.4 years, 63.5% men, were studied. Most died in inpatient settings (64%), at home (22%), or in nursing homes (13%). Five health care trajectory types were identified. Types 1 (n=13,954) and 2 (n=53,304) include the majority, managed consistently with LABA/LAMA and ICS, respectively, with frequent pulmonologist consultations. Type 3 (n=14,331) includes more comorbid patients receiving few therapies and only SABA/SAMA, with fewer pulmonologist visits and more deaths in nursing homes. COPD appears secondary in management. Types 4 (n=8,542) and 5 (n=18,704) comprise patients without inhaled therapy, without or with exacerbations, respectively, often dying in nursing homes, highly comorbid, with non-severe COPD and low pulmonologist consultation rates.
CONCLUSIONS: We successfully disaggregated five care pathway typologies, analysed them, and identified which ones appear to be appropriate or not. The graphical representations from the R TraMiner package will provide a better visualization of the created pathway types and will offer additional comprehensive information.
METHODS: Patients with COPD between 2017 and 2022 were identified by ICD10 codes: J42 or J43 or J44 in the French National Health Data System. Within this population, patients who died (main cause on death certificate) from COPD or respiratory infection associated with COPD, or from Cardiovascular Disease (CD) between 2017 and 2022 were included in the analysis. Inhaled drug dispensation: short acting bronchodilators (SABA/SAMA), long acting bronchodilators (LABA/LAMA) and corticosteroids (ICS) are the main treatment of the COPD and allow to limit exacerbation risk and symptoms. They were used to describe healthcare pathway within 12 months prior to death. Optimal matching & hierarchical classification methods were used for the analyse of care pathway.
RESULTS: A total of 108,835 patients (67,250 COPD and 41,585 CD), average age 81.4 years, 63.5% men, were studied. Most died in inpatient settings (64%), at home (22%), or in nursing homes (13%). Five health care trajectory types were identified. Types 1 (n=13,954) and 2 (n=53,304) include the majority, managed consistently with LABA/LAMA and ICS, respectively, with frequent pulmonologist consultations. Type 3 (n=14,331) includes more comorbid patients receiving few therapies and only SABA/SAMA, with fewer pulmonologist visits and more deaths in nursing homes. COPD appears secondary in management. Types 4 (n=8,542) and 5 (n=18,704) comprise patients without inhaled therapy, without or with exacerbations, respectively, often dying in nursing homes, highly comorbid, with non-severe COPD and low pulmonologist consultation rates.
CONCLUSIONS: We successfully disaggregated five care pathway typologies, analysed them, and identified which ones appear to be appropriate or not. The graphical representations from the R TraMiner package will provide a better visualization of the created pathway types and will offer additional comprehensive information.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH120
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Public Health, Safety & Pharmacoepidemiology
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)