Economic Burden of Uncontrolled COPD Under Triple Therapy: A Population-Based Study

Objective: This study aimed to provide real-life data on COPD healthcare resource utilization (HCRU)-related costs in patients receiving triple therapy and to quantify the economic burden of uncontrolled COPD patients (ie, ≥1 severe or 2 moderate exacerbations within 12 months before inclusion and at least one exacerbation under treatment) versus controlled COPD patients and the general population. Methods: Patients aged over 40 years receiving triple therapy in 2015 (ie, long-acting ß2-agonist, long-acting anticholinergic and inhaled corticosteroids) for at least 90 continuous days were included. The index date was defined as the 91st day of triple therapy exposure. Patients were followed for up to 5 years. HCRU-costs were computed by calendar year in controlled and uncontrolled COPD patients and in the general population. The association between costs and COPD has been estimated, for each calendar year, using GEE with a negative binomial distribution. Results: Among the 186,963 patients included, 21.2% (N= 39,647) of patients were identified as uncontrolled. Among these, the average cost related to HCRU per patient was around 12,000€ by year. Hospitalizations, drugs and medical devices represented approximately 2/3 of expenses. Costs were in average 1.25 higher than in controlled COPD treated patients and 2.7 higher than the general population. Attributable costs to COPD in uncontrolled patients were estimated at approximately €7,600 per patient each year. Conclusion: This study offers a robust representation of health care resource consumption and related costs of COPD patients receiving triple therapy in France over several years with a focus on uncontrolled patients.