OBJECTIVES: To estimate annual healthcare resource utilization (HCRU) and related costs in COPD patients at high risk of exacerbation despite dual or triple inhaled maintenance therapy, by exacerbation history.

METHODS: A retrospective cohort study was conducted in the US using Optum’s Market Clarity Database between 2015-2019. Subjects aged ≥40 years with COPD diagnosis were identified. Index date started after the following criteria were met: patients had (1) a continuous 12-month baseline period of treatment with dual/triple maintenance inhaler between 2016–2018; (2) evidence of either ≥2 moderate (group A) or ≥1 severe (group B) exacerbation during that baseline period. Patients were followed up for another fixed 12-months from index date. All-cause and COPD-related HCRU (outpatient and emergency room (ER) visits, hospitalizations and medication dispensation) and associated standardized costs were described separately in group A and B patients, during the baseline and follow-up periods.

RESULTS: 11,150 subjects were identified; mean age=62.5 years (SD=10.2), 36% were male and 45% were covered by Medicare. Overall, 3,290 (30%) and 7,860 (70%) of individuals were on triple therapy and dual therapy at baseline, respectively, and 6,329 (57%) and 4,821 (43%) of subjects were in group A and B, respectively. During the baseline period, average all-cause costs were $44,098 for individuals in group A and $108,195 for individuals in group B. During the 12-month follow-up, average all-cause costs were $47,161 (group A) and $78,135 (group B). Mean all-cause ER visits were 2.5 (SD=6.0) and 3.7 (SD=8.6) in group A and group B at follow-up, and mean all-cause hospitalization events were 0.4 (SD=1.1) in group A and 1.2 (SD=2.5) in group B.

CONCLUSIONS: COPD patients at risk of exacerbation despite dual or triple therapy incur substantial medical costs. Further management options need to be developed for this high-risk population to decrease the economic burden of COPD.