Health care resource use and costs associated with prompt initiation of budesonide/glycopyrrolate/formoterol fumarate among patients with copd: the eros study

SESSION TITLE: Optimizing Health Care Delivery in COPD SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:40 pm PURPOSE: Exacerbations of chronic obstructive pulmonary disease (COPD) cause significant morbidity and mortality. Global Initiative for Obstructive Lung Disease (GOLD) guidelines recommend considering initial treatment with, or escalation to, triple therapy in patients who have experienced exacerbations and have elevated blood eosinophil levels. This study examined whether prompt initiation of budesonide/glycopyrrolate/formoterol fumarate (BGF) triple therapy after an exacerbation is associated with lowered costs and healthcare resource utilization (HCRU) compared to patients for whom therapy is delayed. METHODS: The EROS study was a retrospective analysis of patients with COPD in the MORE2 Registry® claims database. Patients were required to present with either: ≥1 severe exacerbation, ≥2 moderate exacerbations, or ≥1 moderate exacerbation while on non-triple maintenance treatment (earliest qualifying exacerbation = index date). In the 12-month period following the index exacerbation, all patients were required to have ≥1 pharmacy claim for BGF. Patients were required to be ≥40 years old on the index date, continuously enrolled for 12 months before and ≥3 months after index, and did not present use of single inhaler triple therapy (SITT) in the 12-month pre-index period. Unadjusted mean (median) annualized healthcare costs (all-cause, COPD related) and HCRU (inpatient [INP], emergency department [ED] and office visits [OV]) were presented and stratified by the timing of post-index BGF initiation: prompt (≤30 days), delayed (31–180 days), and very delayed (181–365 days), and analyzed using the Kruskal-Wallis test. RESULTS: 2,409 patients qualified for the study: 434 prompt, 1,187 delayed, and 788 very delayed initiation of BGF. Annualized all-cause mean (median) healthcare costs were $25,289 ($15,446), $31,404 ($17,277) and $28,901 ($18,653) for prompt, delayed and very delayed BGF initiation, respectively (P <0.05 overall). Similar associations were observed for COPD-related HCRU, with healthcare costs of $5,002 ($2,235), $7,639 ($3,786) and $8,724 ($5,076) for prompt, delayed and very-delayed patients, respectively (P <0.01). Additionally, the mean annualized hospitalization rate was 0.53 per patient for the prompt group, approximately 36% lower than the delayed (0.83) and very delayed (0.83) groups (P <0.01 for both). CONCLUSIONS: Among patients with COPD, promptly initiating BGF following a moderate or severe exacerbation was associated with a 19.4% and 12.4% reduction in annualized all-cause healthcare costs and a 34.5% and 42.6% reduction in annualized COPD related costs compared to “delayed” and “very delayed” BGF initiation, respectively. CLINICAL IMPLICATIONS: Proactive COPD management, including use of triple therapies, may be both clinically and economically effective for patients, providers, and plans. DISCLOSURES: Employee relationship with Inovalon Please note: 5/1/2022 - Present Added 04/05/2023 by Barnabie Agatep, source=Web Response, value=Consulting fee Employee relationship with AstraZeneca Please note: >$100000 by Devechio Edwards, value=Salary Employee relationship with AstraZeneca Pharmaceuticals LP Please note: >$100000 by Norbert Feigler, value=Salary Employee relationship with Inovalon Please note: 2022 - present Added 03/29/2023 by Benjamin Lewing, source=Web Response, value=Salary Employee relationship with AstraZeneca Please note: March 2019 by Sushma Patel, value=Salary Employee relationship with AstraZeneca Please note: >$100000 by Michael Pollack, value=Salary Advisory Committee Member relationship with AstraZeneca Please note: 9/1/2020-present Added 04/05/2023 by Edward Portillo, value=Consulting fee Employee relationship with Inovalon Please note: 2022-2023 Added 04/03/2023 by Jill Schinkel, source=Web Response, value=Consulting fee Consultant relationship with Morair Please note: Current by Charlie Strange, value=Consulting fee Employee relationship with AlphaNet Please note: Current by Charlie Strange, value=Salary Scientific Medical Advisor relationship with Vertex Please note: Current by Charlie Strange, value=Grant/Research Support Grant to University relationship with Adverum Please note: Current by Charlie Strange, value=Grant/Research Support Consultant relationship with Takeda Please note: Current by Charlie Strange, value=Consulting fee Consultant relationship with Inhibrx Please note: Current by Charlie Strange, value=Travel Consultant relationship with AstraZeneca Please note: 2019-Present by Charlie Strange, value=Consulting fee Consultant relationship with Pulmanage Please note: Current by Charlie Strange, value=Consulting fee Grant to University relationship with Arrowhead Please note: Current by Charlie Strange, value=Grant/Research Support Grant recipient to University relationship with Chesi Please note: 2023- Present Added 03/31/2023 by Charlie Strange, source=Web Response, value=Grant/Research Support Research monies paid to University relationship with Grifols Please note: Current by Charlie Strange, value=Grant/Research Support Research Grant to institution relationship with NuVaira Please note: 2020-Present by Charlie Strange, value=Grant/Research Consultant relationship with CSA Medical Please note: 2019-Present by Charlie Strange, value=Grant/Research Support Consultant relationship with Glaxo Smith Kline Please note: 2019- Present by Charlie Strange, value=Consulting fee Removed 03/31/2023 by Charlie Strange, source=Web Response Consultant relationship with Uptake Medical Please note: 2019-2020 by Charlie Strange, value=Consulting fee Employee relationship with AstraZeneca Please note: 2018-2023 Added 04/05/2023 by Sean Swisher, source=Web Response, value=Salary Consultant relationship with Insmed Please note: 3/22 to present Added 03/29/2023 by Joseph Tkacz, source=Web Response, value=Grant/Research Support Consultant relationship with AstraZeneca Please note: 3/18 to present Added 03/29/2023 by Joseph Tkacz, value=Grant/Research Support Consultant relationship with Monument Analytics Please note: Jul 2019-present by Daniel Touchette, value=Consulting fee Consultant relationship with Astra Zeneca Please note: Oct 2020- present by Daniel Touchette, value=Consulting fee