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Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts
 

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Does Baseline Exacerbation History in COPD Predict Future Exacerbation Frequency? Real World Insights from Multiple US Insurers

Session Title
TP41 - TP041 DIAGNOSIS AND RISK ASSESSMENT IN COPD
Abstract
A2297 - Does Baseline Exacerbation History in COPD Predict Future Exacerbation Frequency? Real World Insights from Multiple US Insurers
Author Block: J. Dreyfus1, C. Moretz1, S. Kumar1, S. Sethi2, M. Pollack3, B. J. Make4, S. Robinson1, D. Powell1, N. Feigler3, A. Xi1; 1Avalere, Washington, DC, United States, 2University at Buffalo, Buffalo, NY, United States, 3AstraZeneca, Wilmington, DE, United States, 4Natl Jewish Health, Denver, CO, United States.
Rationale: Chronic obstructive pulmonary disease (COPD) exacerbations are an important cause of morbidity and mortality. While exacerbation history can be a predictor of future exacerbations little is known about these risks across payer types. The objective of this study was to assess the rate of exacerbations in patients categorized by frequency and severity of baseline exacerbations by payer. Methods: This retrospective study utilized claims data from Medicare Fee-for-Service (FFS) and from multiple U.S. commercial (COM), Managed Medicaid (MM), and Medicare Advantage (MA) plans using the Inovalon MORE2 Registry®. Patients were aged ≥40 years and continuously enrolled. Index date was first hospitalization, emergency department visit, or first of two outpatient visits during 2015 with a diagnosis of chronic bronchitis, emphysema, or chronic airway obstruction. Year 1 baseline exacerbation rates were used to classify patients into categories (A-E, see table). Moderate exacerbations are defined as COPD-related outpatient/ED visits with a corticosteroid/antibiotic claim within ±7 days of the visit. Severe exacerbations are hospitalizations with primary COPD diagnosis. Exacerbations occurring ≤14 days apart were considered one episode, with highest severity assigned. Rate ratios (RR) for Categories B-E were compared to Category A (no baseline exacerbations) for Year 2 and Year 3 using generalized linear model (GLM) unadjusted and adjusted for relevant covariates (p<0.05). Results: A total of 1,555,891 patients met selection criteria: FFS- 95.9%, MM- 1.6%, MA- 1.6%, and COM- 0.9%; 70% had a baseline COPD diagnosis. Overall, 61.8% of patients did not have exacerbations during baseline year (Category A), 31.4% had ≥1 moderate exacerbation and 6.7% had ≥1 severe exacerbation. Per patient rates of exacerbations were highest for FFS (0.52) compared to MA (0.45), MM (0.37) and COM (0.23). Compared to other payers, approximately 20% of MM exacerbations were severe (7.5% COM, 14.1% MA, 15.8% FFS). Across all payers types, rates and risks of future exacerbations were higher in all Categories B-E compared to Category A. Adjusted risks of future exacerbations were found to be relatively similar among patients with one baseline exacerbation (B and D) compared to Category A regardless if the baseline exacerbation event was moderate or severe. Conclusion: In patients with COPD, increased likelihood and rate of subsequent exacerbations was observed across all payer types for those with baseline events; even one moderate outpatient exacerbation event is a predictor of future exacerbation events. Exacerbation history should be considered when determining treatment strategies to minimize risks of future exacerbations.