The Burden Of Chronic Obstructive Pulmonary Disease (COPD) In Finland: Impact Of Disease Severity And Eosinophil Count On Healthcare Resource Utilization

Abstract

Purpose

The burden associated with chronic obstructive pulmonary disease (COPD) is substantial. The objectives of this study were to describe healthcare resource utilization (HCRU) and HCRU-associated costs in patients with COPD in Finland, according to disease severity and blood eosinophil count (BEC).

Patients and methods

This non-interventional, retrospective registry study (GSK ID: HO-17-17558) utilized data from the specialist care hospital register. Data extraction was from first hospital visit with a COPD diagnosis (index date) from January 1, 2004 until December 31, 2015 or death. Patients (aged >18 years with ≥1 report of post-bronchodilation forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC) ratio <0.7) were categorized as having non-severe or severe COPD (FEV₁ >50% or ≤50% of reference, respectively). Patients who were initially non-severe but progressed to severe were classified as having progressing COPD. Patients without spirometry registry data were classified as having clinically verified COPD. Patients were grouped according to BEC (≥300 cells/μL, <300 cells/μL or BEC unknown). HCRU, estimated associated costs and mortality were evaluated according to COPD severity and BEC.

Results

There were 9042 patients with COPD; 340 non-severe, 326 progressing, 394 severe, and 7982 clinically verified. BEC was available for 31.8% of patients. The mean follow-up time was 3.7–6.5 years in the classified patient-groups. All-cause mortality was 46% during follow-up. Severe COPD was associated with more COPD-related HCRU and higher mortality than non-severe COPD. Patients with BEC ≥300 cells/μL had higher overall HCRU but improved survival compared with those with BEC <300 cells/μL. Overall direct costs were similar across COPD severity categories, 3300–3900€/patient-year, although COPD-related costs were higher in patients with severe versus non-severe COPD.

Conclusion

This study demonstrated a substantial burden associated with severe and/or eosinophilic COPD for patients in Finland.

Keywords:

• severe COPD
• severe eosinophilic COPD
• prevalence
• healthcare costs
• mortality

Acknowledgments

This study was funded by GSK (GSK ID: HO-17-17558). The authors would like to thank the staff at the Centre for Clinical Informatics at Turku University Hospital for their assistance with data extraction and harmonization. Editorial support (in the form of writing assistance, including the development of the initial draft based on author direction, assembling tables, and figures, collating authors’ comments, grammatical editing and referencing) was provided by Laura Pearce PhD, at Fishawack Indicia Ltd, UK, and was funded by GSK.

Abbreviations

ACO, asthma-COPD overlap; BEC, blood eosinophil count; BMI, body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ER, emergency room; FEV₁, forced expiratory volume in 1 s; FVC, forced vital capacity; HCRU, healthcare resource utilization; HDSWF, Hospital District of Southwest Finland; ICD, International Classification of Diseases; SD, standard deviation.

Ethics Approval And Informed Consent

The permission for this registry-based study was obtained from the Hospital District of Southwest Finland, Kela and Statistics Finland. According to Finnish law for retrospective registry studies, no informed consent was needed.

Data Availability

GSK makes available-anonymized individual participant data and associated documents from interventional clinical studies which evaluate medicines, upon approval of proposals submitted to www.clinicalstudydatarequest.com. To access data for other types of GSK sponsored research, for study documents without patient-level data and for clinical studies not listed, please submit an enquiry via www.clinicalstudydatarequest.com. The sharing of a de-identified dataset of this study is restricted by Finnish law (Data Protection Act (1050/2018)). The dataset can only be requested through the permit authorization process from Turku Clinical Research Centre for justifiable research projects (http://www.turkucrc.fi/en).

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

AV has served as a scientific advisory board member for AstraZeneca, GSK and Novartis, has received lecture fees from Astra-Zeneca, Chiesi, Boehringer Ingelheim, Mundipharma, and Novartis, and has participated in congresses and educational lectures with support from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis, and Roche. ML and IT are employees of Medaffcon Oy. AK has received lecture fees from Bayer. LV and JI-H are employees of GSK and JI-H holds shares in GSK. TL has served as a scientific advisory board member for GSK, has performed research sponsored by GSK, and has received funding from GSK to participate in a scientific conference. The authors report no other conflicts of interest in this work.