COPD Treatment Ratio Provides Metric for Exacerbation Risk

January 18, 2019
Caitlyn Bahrenburg

As costs of treating COPD exacerbation continue to burden patients, investigators sought to determine a risk assessment tool that could lead to reduced costs.

While previous studies have shown that chronic obstructive pulmonary disease (COPD) exacerbations can speed up disease progression, a new analysis found it may also negatively influence patient healthcare costs.

In a study intended to seek an effective risk assessment strategy for COPD, lead author Richard Stanford, PharmD, MS, explained the ongoing difficulty in identifying appropriate candidates for cost-saving and exacerbation-reducing disease management programs, despite such therapies and interventions becoming more prevalent.

“Further, an assessment that could be calculated using readily-accessible medical data to measure exacerbation risk was not readily available,” Stanford explained. “As a result, our research team sought to understand if an easy to calculate risk ratio that uses pharmacy dispensing data would be an effective measure to help health plans and institutions identify patients that were at a higher risk for a COPD-related hospitalization.”

Investigators found that use of a COPD treatment ratio (CTR) has been shown to provide a modifiable measure of risk of COPD exacerbation in a large commercial and Medicare population, and remained a strong predictor in circumstances when pharmacy-only data claims were available.

The retrospective observational study was conducted utilizing Humana research datasets. A separate assessment was performed utilizing pharmacy-only models that excluded risk factors sourced from medical claims.

A total of 92,496 patients were identified, of which 96.2% were Medicare members with a median age of 69 years. Throughout the baseline period of the study, 14% of patients had moderate exacerbation, while 11% had severe exacerbation.

“Overall, the CTR performed well in predicting future COPD exacerbations, especially severe exacerbations,” investigators wrote. “ROC analysis suggested that 0.7 was the optimal cut-point for dichotomizing CTR.”

Investigators further found that patients with a CTR ≥ 0.7 had a 7.9% reduced risk of severe exacerbation than other patients. In pharmacy-only models, the disparity was more significant: patients with a CTR ≥ 0.7 were 17% less likely to experience a severe exacerbation than other patients.

Stanford noted this is third independent population and dataset used to test CTR. The incremental increase of 0.1 in the ratio are associated with incremental reductions in COPD-related hospitalization risk.

“Based on these findings, disease management programs that can improve the CTR by 10% should improve overall outcomes of their targeted COPD population,” Stanford said. “Ultimately, the results of the study stands to have significant impacts on the ways in which COPD is treated, as well as the cost of managing COPD.”

Standord called for the development of risk assessment measures, in order to properly identify at-risk patients and prevent future exacerbations. The CTR may fill that role.

“Based on the findings from this study, incorporation of the CTR into COPD disease management programs that are designed to improve adherence and reduce COPD symptoms could ultimately reduce COPD related hospitalization and costs,” Stanford said.

The study, "External Validation of a COPD Risk Measure in a Commercial and Medicare Population: The COPD Treatment Ratio,” was published online in JMCP.

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