Short- and Long-Term Impact of Prior Chronic Obstructive Pulmonary Disease Exacerbations on Healthcare Resource Utilization and Related Costs: An Observational Study (SHERLOCK)

Abstract

The observational retrospective cohort Study on HEalthcare Resource utiLization (HCRU) related to exacerbatiOns in patients with COPD (SHERLOCK; D5980R00014) evaluated exacerbation-related HCRU and costs using the U.K. National Health Service Greater Glasgow and Clyde Health Board data. Patients (≥40 years) with COPD were stratified by exacerbations one year before the index date: Group A (none), B (1 moderate), C (1 severe) and D (≥2 moderate and/or severe). All-cause and COPD-related HCRU and costs were assessed over 36 months. Adjusted rate ratios (RRs) or relative costs versus Group A were estimated using generalized linear models with appropriate distributions and link functions. The study included 22 462 patients (Group A, n = 7788; B, n = 5151; C, n = 250 and D, n = 9273). At 12 months, RRs (95% CI) versus Group A for all-cause and COPD-related HCRU, respectively, were highest in Groups C (1.28 [1.18, 1.39] and 1.18 [1.09, 1.29]) and D (1.26 [1.23, 1.28] and 1.29 [1.26, 1.31]). General practitioner and outpatient visits, and general ward stays/days accounted for the greatest COPD-related HCRU. All-cause and COPD-related relative costs (95% CI) versus Group A at 12 months, respectively, were 1.03 (0.94, 1.12) and 1.06 (0.99, 1.13) in Group B; 1.47 (1.07, 2.01) and 1.54 (1.20, 1.97) in Group C; 1.47 (1.36, 1.58) and 1.63 (1.54, 1.73) in Group D. Increased HCRU and costs in patients with exacerbation histories persisted at 36 months, demonstrating the sustained impact of exacerbations. The study suggests the importance of management and prevention of exacerbations through intervention optimization and budgeting by payers for exacerbation-related costs.

Keywords:

• Chronic obstructive pulmonary disease
• exacerbation severity
• healthcare resource utilization
• healthcare costs
• exacerbation history

Acknowledgments

Medical writing support, under the direction of the authors, was provided by Sara Cameron, MPhil, CMC Connect, a division of IPG Health Medical Communications, funded by AstraZeneca in accordance with Good Publication Practice (GPP 2022) guidelines [28]. All authors were involved in the design and conduct of the study and in the interpretation of the data. All authors were involved in the writing of the manuscript and the final decision to submit to COPD: Journal of Chronic Obstructive Pulmonary Disease.

Data availability statement

Remote access to this dataset was provided to the study statisticians via Safe Haven. Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data are not available.

Declaration of interest

Enrico de Nigris was an employee of AstraZeneca at the time this study was conducted. Bo Ding is an employee of AstraZeneca. John Haughney reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Circassia and Teva unrelated to the conduct of the study. Amanda Lee and Mintu Nath have no conflicts to disclose. Hana Müllerová and Ulf Holmgren are employees and hold stock and/or stock options in AstraZeneca.

Previous presentation

These data were reported at the 2020 International Society for Pharmacoeconomics and Outcomes Research European Virtual Congress (16 − 19 November 2020). Data reporting the associations between exacerbation history and rates of the subsequent COPD exacerbations from this study were presented at the 2020 European Respiratory Society International Virtual Congress (5 − 9 September 2020).

Additional information

Funding

This study was sponsored by AstraZeneca. AstraZeneca authors were involved in the design of the study; in the analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.