Oral corticosteroid-related healthcare resource utilisation in patients with COPD

Introduction and Objectives: Oral corticosteroids (OCS) are sometimes used to manage exacerbations in patients with chronic obstructive pulmonary disease (COPD). Evidence suggests chronic OCS use is related to adverse outcomes, which may be associated with additional healthcare resource utilisation (HCRU) and costs. The objective of this study was to compare HCRU in patients who ever or never used OCS (OCS vs non-OCS cohorts) and to examine associations between cumulative OCS exposure and HCRU/costs.

Methods: This matched historical observational cohort study used the UK Clinical Practice Research Datalink (1987–2019). Patients with a COPD diagnosis on/after 1 April 2003 and Hospital Episode Statistics linkage were included. Attendances for emergency room, specialist or primary care (PC) outpatient and inpatient visits were analysed. Costs were estimated using Health and Social Care 2019 and NHS Reference Costs 2019–2020 reports.

Results: Compared with the non-OCS cohort, the OCS cohort had higher annualised total attendances and costs (Table). Compared with patients with cumulative OCS doses <0.5 g, patients with higher cumulative doses had higher costs (incidence rate ratios; 95% CI) starting at 0.5–<1.0 g for specialist consultations (1.91; 1.89, 1.93), inpatient non-elective short stays (1.10; 1.09, 1.12) and long stays (1.039; 1.036, 1.042) and PC consultations (1.274; 1.267, 1.281).

Conclusions: OCS use is associated with increased HCRU and costs, with a positive dose–response relationship