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

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 ﬁ rst 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 (FEV 1 )/forced vital capacity (FVC) ratio <0.7) were categorized as having non-severe or severe COPD (FEV 1 >50% or ≤ 50% of reference, respectively). Patients who were initially non-severe but progressed to severe were classi ﬁ ed as having progressing COPD. Patients without spirometry registry data were classi ﬁ ed as having clinically veri ﬁ ed COPD. Patients were grouped according to BEC ( ≥ 300 cells/ μ L, <300 cells/ μ L 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 veri ﬁ ed. BEC was available for 31.8% of patients. The mean follow-up time was 3.7 – 6.5 years in the classi ﬁ ed 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/ μ L had higher overall HCRU but improved survival compared with those with BEC <300 cells/ μ L. 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. This study was designed to assess the amount of healthcare resource utilization (HCRU) and associated costs for patients with COPD who had different levels of disease severity. In this study, data from adult patients from specialty health care in Finland with COPD were analyzed. Total HCRU and COPD-speci ﬁ c HCRU were investigated, along with estimated associated costs between the years 2004 – 2015. We found that patients with severe COPD had higher HCRU compared with those who had non-severe COPD. COPD-related HCRU costs were highest in patients with severe COPD and total costs in patients with severe COPD who had an elevated level of eosinophils. COPD but no post-bronchodilation spirometry data in the registry. forced expiratory volume in 1 s; FVC, forced vital The present real-world study clearly demonstrates that COPD represents a substantial healthcare burden in Finland, which appears to be particularly high in patients with severe COPD and probably also in patients with severe eosinophilic disease. The association of eosinophilia with better survival needs to be con ﬁ rmed in future studies. This study supports the measurement of blood eosinophils in COPD-patients.