OBJECTIVES: Chronic obstructive pulmonary disease (COPD) constitutes a major burden for both patients and the healthcare system, often resulting in frequent healthcare resource utilization (HRU). An important goal of COPD treatment is to reduce exacerbations, which are the source of high HRU. This study aims to assess HRU before and after starting treatment with commonly used inhaled corticosteroid-containing COPD maintenance regimens [long-acting beta₂-agonist/inhaled corticosteroid (LABA/ICS) or long-acting muscarinic antagonist (LAMA), LABA, and ICS (LAMA/LABA/ICS)].

METHODS: A retrospective cohort study of Optum’s Clinformatics Datamart identified COPD patients ≥40 years old who initiated new COPD maintenance therapy with LABA/ICS or LAMA/LABA/ICS (single inhaler) between January 2016 and June 2023. Index date was the first COPD maintenance therapy prescription claim. Patients included had 12 months of continuous enrollment before and after the index date. COPD-related HRU [including emergency department visits (ED), hospitalizations, 90-day readmissions among those who were hospitalized] were assessed in the pre-index and post-index period.

RESULTS: 137,691 patients were included. 66,493 (48.3%) patients started LABA/ICS and 12,482 (9.1%) started LAMA/LABA/ICS. With LABA/ICS, COPD-related ED visits and hospitalizations occurred in 8.0% and 4.7%, respectively, in the pre-index period and were reduced to 5.1% and 3.0% in the post-index period (both p<0.001). With LAMA/LABA/ICS, COPD-related ED visits and hospitalizations were reduced, occurring in 6.7% and 3.2% in the pre-index period, respectively, and 4.4% and 2.4% in the post-index period (both p<0.001). Patients experiencing 90-day COPD-related hospital readmissions increased from the pre-index period to the post-index period. For LABA/ICS, readmissions occurred in 7.1% pre-index and 16.9% post-index (p<0.001); for LAMA/LABA/ICS, readmissions occurred in 6.1% pre-index and 16.4% post-index (p=0.004).

CONCLUSIONS: Patients continue to experience COPD-related ED visits and hospitalizations despite reductions in exacerbations with common ICS-containing maintenance regimens. Interestingly, 90-day hospital readmissions increased post-treatment initiation, which may be related to ICS initiation among patients with more severe COPD.