Risk factors for a patient’s first severe chronic obstructive pulmonary disease (COPD) exacerbation include advanced age, previous outpatient-treated exacerbations, use of rescue medication and chronic oxygen therapy, and type of COPD, according to a recent study in The American Journal of Managed Care.

The study, which used health insurance claims data from a pair of managed care databases (Truven Health MarketScan and Reliant Medical Group), also found that patients with a COPD treatment (controller and ratio) ratio (CTR) of 0.3 or greater had a 14% lower risk of having a severe COPD exacerbation the following year.

“The main advantage of the risk model and the CTR measure is that they do not rely on medical records, which are often unavailable to quality-of-care organizations and payers,” researchers wrote. “Unlike previously reported measures, the CTR can be used to specifically assess the risk of first severe exacerbation and may help to identify which patients should be targeted for more intense management so that hospitalizations and costs could be reduced.”

According to the study, medical costs associated with COPD are projected to grow from $32.1 billion in 2010 to $49 billion in 2020. Knowing which patients are most at risk for a first severe COPD exacerbation is essential for early preventive treatment and potentially stemming costs.

Researchers developed and validated their claims-based risk model using claims data for 223,824 patients. Both the risk model and the CTR can accurately predict the likelihood of a patient’s first severe COPD exacerbation, researchers concluded.

“The use of this risk model and the CTR may allow policy makers, providers, and payers to identify those patients at highest risk for their first COPD-related hospitalization,” they wrote. “Ultimately, the CTR coupled with other HEDIS [Healthcare Effectiveness Data and Information Set] measures has the potential to improve the management of patients at risk of developing severe COPD exacerbations, thus avoiding worsening of the disease and significant downstream costs.” —Jolynn Tumolo

Insight From the Author

In order to better understand how these findings could impact managed care professionals, First Report Managed Care spoke with lead researcher Richard H Stanford, PharmD, MS, Senior Director of Customer Engagement Value Evidence and Outcomes at GlaxoSmithKline.

How can the claims-based risk model reduce costs among COPD patients?

This risk model can possibly help payers and other large groups identify COPD patients at risk for COPD related hospitalizations, so disease management programs that target these patients could potentially reduce the frequency and or severity of COPD exacerbations and potentially lead to cost savings.

Can this strategy be implemented among other patient populations?

Yes, a similar risk model, the asthma medication ratio (AMR), is currently being used in asthma.

 How do severe exacerbations impact the costs of COPD for both the patient and the payer?

COPD moderate and severe exacerbations are the primary cost driver for payers in the US, with severe exacerbations in the form of hospitalizations the single largest cost item for most payers.  In addition, reducing these significant events,  also benefit patients by improving COPD care and reducing out of pocket costs that insurance may not cover. 

Do multiple, more moderate exacerbations have less of an impact compared to severe exacerbations? 
In general, COPD patients experience moderate exacerbations more frequently than severe exacerbations, however, our data shows that patients that experience moderate exacerbations are more likely to experience a severe exacerbation.  So, reducing moderate exacerbations can potentially reduce costs and possibly reduce future severe exacerbations

Do you believe this risk model could become widely used, what are the long-term impacts of your study?

The intent was to develop a valid easy to calculate risk model that could be used in various healthcare settings, such as IDN’s, ACO’s and even within PBM’s, that would target patients most likely to experience a COPD exacerbation, specifically a COPD related hospitalization.  We hope the COPD Treatment Ratio would be widely adopted and integrated within disease management programs to improve the long-term management of patients with COPD.

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