OBJECTIVES: The asthma-COPD overlap syndrome (ACOS) is poorly recognized as it is frequently excluded from asthma and COPD clinical trials. We aim to assess health care resource utilization and cost differences among patients with ACOS, asthma, and COPD in a large US administrative healthcare claims database.

METHODS: We conducted a retrospective cohort study among adults in the IQVIA LifeLink Plus® database from 2006-2015. We identified three mutually exclusive cohorts: ACOS, Asthma-only, and COPD-only group, which were categorized based on the inpatient and outpatient claims among those with continuous enrollment 12 months before and after the initial diagnosis (index date) of asthma or COPD. Unadjusted analyses comparing inpatient, emergency department (ED), physician, pharmacy, and total costs in the year prior and the year after the index date using ANOVA. We estimated generalized linear regression models with gamma distribution and log link to examine cost differences among three groups after adjusting for age, gender, geographical region, insurance type, and Charlson comorbidity index.

RESULTS: A total of 352,945 patients were included in the study (ACOS 8.2%, COPD 50.5%, Asthma 41.3%). The ACOS cohort was older (mean age=52.18 years vs. COPD 51.40 years, Asthma 44.15 years, p<.0001) and were more likely to obtain insurance coverage through Medicaid or Medicare (6.60% vs. COPD 5.12%, Asthma 2.78%, p<.0001). ACOS patients experienced the highest cost increase ($4,816) after the initial diagnosis. The multivariate analysis showed that the post-12 month ED, physician, pharmacy, and total cost of ACOS patients were higher than COPD or asthma patients (range from 17%-50% higher, 95%CI range: 1.15-1.53). The COPD group showed the highest inpatient costs (COPD $11,625; ACOS $11,468; Asthma $9,099; p<.0001).

CONCLUSIONS: Patients diagnosed with ACOS incur greater outpatient costs than persons with COPD or asthma alone, which indicated the need for tailored disease management and cost-effective management strategies.