Abstract
Introduction: Oral corticosteroids (OCS) are used to manage chronic obstructive pulmonary disease (COPD) exacerbations but are associated with adverse outcomes that may increase healthcare resource utilization and costs. We compared attendance/costs associated with OCS-related adverse outcomes in patients who ever used OCS versus those who never used OCS and examined associations between cumulative OCS exposure and attendance/costs.
Methods: This direct matched observational cohort study used the UK Clinical Practice Research Datalink GOLD database (data range: 1987–2019). Patients with a COPD diagnosis on/after April 1, 2003, and Hospital Episode Statistics linkage were included. Emergency room, specialist or primary care outpatient, and inpatient attendance were analyzed. Costs, estimated using Health and Social Care 2019 and National Health Service Reference Costs, 2019–2020 reports, were adjusted for sex, age, exacerbation number, and inhaler type used in the 12 months before index date.
Results: The OCS cohort had higher annualized disease-specific (excluding respiratory) total attendance/costs versus the non-OCS cohort (adjusted incidence rate ratio [aIRR] with 95% confidence intervals [CIs]) ranging from 37% (1.37 [1.31, 1.43]) for emergency room attendances to 149% (2.49 [2.36, 2.63]) for specialist consultations. Disease-specific (excluding respiratory) attendance/costs increased in a positive dose–response relationship for most attendance categories versus the <0.5 g reference dose. For the 0.5–<1.0 g
cumulative dose category, the greatest increases in disease-specific (excluding respiratory) attendance/costs occurred for primary care consultations (aIRR [95% CI]: 1.38 [1.32, 1.44]).
For the ≥10 g cumulative dose category, the greatest increases were observed for primary care consultations (aIRR [95% CI]: 2.83 [2.66, 3.00]), non-elective long stays (≥2 days; 2.54 [2.15, 2.99]), and non-elective short stays (≤1 day; 2.51 [2.12, 2.98]). Similar findings were observed for all-cause attendance/costs.
Methods: This direct matched observational cohort study used the UK Clinical Practice Research Datalink GOLD database (data range: 1987–2019). Patients with a COPD diagnosis on/after April 1, 2003, and Hospital Episode Statistics linkage were included. Emergency room, specialist or primary care outpatient, and inpatient attendance were analyzed. Costs, estimated using Health and Social Care 2019 and National Health Service Reference Costs, 2019–2020 reports, were adjusted for sex, age, exacerbation number, and inhaler type used in the 12 months before index date.
Results: The OCS cohort had higher annualized disease-specific (excluding respiratory) total attendance/costs versus the non-OCS cohort (adjusted incidence rate ratio [aIRR] with 95% confidence intervals [CIs]) ranging from 37% (1.37 [1.31, 1.43]) for emergency room attendances to 149% (2.49 [2.36, 2.63]) for specialist consultations. Disease-specific (excluding respiratory) attendance/costs increased in a positive dose–response relationship for most attendance categories versus the <0.5 g reference dose. For the 0.5–<1.0 g
cumulative dose category, the greatest increases in disease-specific (excluding respiratory) attendance/costs occurred for primary care consultations (aIRR [95% CI]: 1.38 [1.32, 1.44]).
For the ≥10 g cumulative dose category, the greatest increases were observed for primary care consultations (aIRR [95% CI]: 2.83 [2.66, 3.00]), non-elective long stays (≥2 days; 2.54 [2.15, 2.99]), and non-elective short stays (≤1 day; 2.51 [2.12, 2.98]). Similar findings were observed for all-cause attendance/costs.
| Original language | English |
|---|---|
| Journal | Advances in Therapy |
| Early online date | 19 Nov 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 19 Nov 2024 |
Bibliographical note
ACKNOWLEDGMENTSAuthor Contributions. All authors made a significant contribution to the work reported. David Price and Victoria Carter contributed to study conception or design, data acquisition, data analysis, and data interpretation. Mona Bafadhel and Alberto Papi contributed to data interpretation. Gary Tse, Cono Ariti, and Jiandong Zhou contributed to data analysis and data interpretation. Derek Skinner contributed to data acquisition, data analysis, and data interpretation. Xiao Xu, Hana Müllerová, and Benjamin Emmanuel contributed to study conception or design and data interpretation. All authors took part in drafting, revising, or critically reviewing the article, gave final approval of the version to be published, have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.
Data Availability Statement
Per the Clinical Practice Research Datalink Independent Scientific Advisory Committee guidance, the data will not be made available for sharing.Keywords
- Chronic obstructive pulmonary disease
- Cohort study
- Corticosteroids
- Cost
- healthcare resource utilization
- Observational
- Primare care