Impact of COPD Exacerbations and Burden of Disease in Spain: AVOIDEX Study

Juan José Soler-Cataluña,1– 3 José Luis Izquierdo,4,5 Mónica Juárez Campo,6 Antoni Sicras-Mainar,7 Javier Nuevo6 1Pneumology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain; 2Medicine Department, Universitat de València, Valencia, Spain; 3CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; 4Medicine and Medical Specialties Department, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; 5Respiratory Medicine Department, Hospital Universitario de Guadalajara, Guadalajara, Spain; 6Medical Department, AstraZeneca MC, Madrid, Spain; 7Health Economics and Outcomes Research Department, Atrys Health SA, Barcelona, SpainCorrespondence: Juan José Soler-Cataluña, Pneumology Department, Hospital Arnau de Vilanova-Lliria, Carrer de Sant Clement, 12, València, 46015, Spain, Tel +34 961 97 60 00, Fax +34 963868580, Email jjsoler@telefonica.netPurpose: Chronic obstructive pulmonary disease (COPD) is characterized by high morbidity and mortality, with a considerable consumption of healthcare resources (HRU). This study aims to obtain real world evidence regarding the consequences of COPD exacerbations and to provide updated data on the burden of this disease and its treatment.Patients and Methods: A retrospective study in seven Spanish regions was conducted among COPD patients diagnosed between 1/01/2010 and 31/12/2017. The index date was the diagnosis of COPD and patients were followed until lost to follow-up, death or end of the study, whichever occurred first. Patients were classified by patient pattern (incident or prevalent), type and severity of exacerbations, and treatments prescribed. Demographic and clinical characteristics were evaluated, together with the incidence of exacerbations, comorbidities, and the use of HRU, during the baseline (12 months before the index date) and the follow-up periods by incident/prevalent and treatment prescribed. Mortality rate was also measured.Results: The study included 34,557 patients with a mean age of 70 years (standard deviation: 12). The most frequent comorbidities were diabetes, osteoporosis, and anxiety. Most patients received inhaled corticosteroids (ICS) with long-acting beta agonists (LABA), or long-acting muscarinic agonists (LAMA), followed by LABA with LAMA. Incident patients (N=8229; 23.8%) had fewer exacerbations than prevalent patients (N=26328; 76.2%), 0.3 vs 1.2 exacerbations per 100 patient-years. All treatment patterns present a substantial disease burden, which seems to increase with the evolution of the disease (ie moving from initial treatments to combination therapies). The overall mortality rate was 40.2 deaths/1000 patient-years. General practitioner visits and tests were the HRU most frequently required. The frequency and severity of exacerbations positively correlated with the use of HRU.Conclusion: Despite receiving treatment, patients with COPD suffer a considerable burden mainly due to exacerbations and comorbidities, which require a substantial use of HRU.Keywords: COPD, real-world evidence, clinical practice, triple therapy, ICS, LABA, LAMA