PMID- 32967697 OWN - NLM STAT- MEDLINE DCOM- 20210518 LR - 20210518 IS - 1750-1172 (Electronic) IS - 1750-1172 (Linking) VI - 15 IP - 1 DP - 2020 Sep 23 TI - Medical costs of Alpha-1 antitrypsin deficiency-associated COPD in the United States. PG - 260 LID - 10.1186/s13023-020-01523-4 [doi] LID - 260 AB - BACKGROUND: There are limited data on economic aspects of the genetic variant of chronic obstructive pulmonary disease (COPD) in the context of the more prevalent form of COPD. The objective of this study was to isolate the healthcare resource utilization and economic burden attributable to the presence of a genetic factor among COPD patients with and without Alpha-1 Antitrypsin Deficiency (AATD), twelve months before and after their initial COPD diagnosis. METHODS: Retrospective analysis of OptumLabs(R) Data Warehouse claims (OLDW; 2000-2017). The OLDW is a comprehensive, longitudinal real-world data asset with de-identified lives across claims and clinical information. AATD-associated COPD cases were matched with up to 10 unique non-AATD-associated COPD controls. Healthcare resource use and costs were assigned into the following categories: office (OV), outpatient (OP), and emergency room visits (ER), inpatients stays (IP), prescription drugs (RX), and other services (OTH). A generalized linear model was used to estimate total pre- and post-index (initial COPD diagnosis) costs from a third-party payer's perspective (2018 USD) controlling for confounders. Healthcare resource utilization was estimated using a negative binomial regression. RESULTS: The study population consisted of 8881 patients (953 cases matched with 7928 controls). The AATD-associated COPD cohort had higher expenditures and use of office visits (OV) and other (OTH) services, as well as OV, outpatient (OP), emergency room (ER), and prescription drugs (RX) before and after the index date, respectively. Adjusted total all-healthcare cost ratios for AATD-associated COPD patients as compared to controls were 2.04 [95% CI: 1.60-2.59] and 1.98 [95% CI: 1.55-2.52] while the incremental cost difference totaled $6861 [95% CI: $3025 - $10,698] and $5772 [95% CI: $1940 - $9604] per patient before and after the index date, respectively. CONCLUSIONS: Twelve months before and after their initial COPD diagnosis, patients with AATD incur higher healthcare utilization costs that are double the cost of similar COPD patients without AATD. This study also suggests that increased costs of AATD-associated COPD are not solely attributable to augmentation therapy use. Future studies should further explore the relationship between augmentation therapy, healthcare resource use, and other AATD-associated COPD expenditures. FAU - Sieluk, Jan AU - Sieluk J AUID- ORCID: 0000-0002-1833-0273 AD - Pharmaceutical Health Services Research Department, University of Maryland, School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA. AD - OptumLabs Visiting Fellow, OptumLabs, Cambridge, MA, USA. FAU - Slejko, Julia F AU - Slejko JF AD - Pharmaceutical Health Services Research Department, University of Maryland, School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA. FAU - Silverman, Henry AU - Silverman H AD - University of Maryland School of Medicine, Baltimore, MD, USA. FAU - Perfetto, Eleanor AU - Perfetto E AD - Pharmaceutical Health Services Research Department, University of Maryland, School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA. AD - National Health Council, Washington, DC, USA. FAU - Mullins, C Daniel AU - Mullins CD AD - Pharmaceutical Health Services Research Department, University of Maryland, School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA. daniel.mullins@rx.umaryland.edu. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200923 PL - England TA - Orphanet J Rare Dis JT - Orphanet journal of rare diseases JID - 101266602 RN - 0 (alpha 1-Antitrypsin) SB - IM MH - Female MH - Health Care Costs MH - Health Expenditures MH - Humans MH - Male MH - *Pulmonary Disease, Chronic Obstructive/complications/epidemiology/etiology MH - Retrospective Studies MH - United States/epidemiology MH - alpha 1-Antitrypsin MH - *alpha 1-Antitrypsin Deficiency/complications/epidemiology PMC - PMC7510284 OTO - NOTNLM OT - Alpha-1 antitrypsin deficiency OT - Chronic obstructive pulmonary disease OT - Cost-of-illness OT - Economic analysis OT - Healthcare resource use OT - Rare disease COIS- Jan Sieluk: Research funding from Bayer HealthCare (recipient: University of Maryland, Baltimore), research funding from AlphaNet (recipient: University of Maryland, Baltimore), research funding from Alpha-1 Foundation (recipient: University of Maryland, Baltimore), research funding from American Association of Colleges of Pharmacy (recipient: University of Maryland, Baltimore); Julia F. Slejko: JFS has received funding for research unrelated to the study from Novartis Pharmaceuticals Corporation, Takeda pharmaceuticals, PhRMA and PhRMA Foundation as well as teaching honorarium from Pfizer, Inc., unrelated to study. Eleanor Perfetto: Dr. Perfetto is employed by the National Health Council which receives membership duesand sponsorship support from a variety of organizations. To see the membership and sponsorship organizations, please see www.nhcouncil.org . Dr. Perfetto has also received grant and contract support from the FDA, Excerpta Medica, and Pfizer Inc. C. Daniel Mullins: Research funding from AlphaNet, Alpha-1 Foundation, Amgen, Bayer, Merck, Novartis, Pfizer (recipient: University of Maryland, Baltimore), consulting income from Amgen, Bayer, Janssen/Johnson & Johnson, MundiPharma, Novartis, Pfizer, Regeneron/Sanofi-Aventis. Robert A. Sandhaus: Medical Director of AlphaNet; medical advisor to Grifols, CSL Behring, Shire, Octapharma, Inhibrx, AstraZeneca; grants from NIH, CSL Behring, Grifols, Matrx. EDAT- 2020/09/25 06:00 MHDA- 2021/05/19 06:00 PMCR- 2020/09/23 CRDT- 2020/09/24 05:25 PHST- 2019/12/13 00:00 [received] PHST- 2020/08/24 00:00 [accepted] PHST- 2020/09/24 05:25 [entrez] PHST- 2020/09/25 06:00 [pubmed] PHST- 2021/05/19 06:00 [medline] PHST- 2020/09/23 00:00 [pmc-release] AID - 10.1186/s13023-020-01523-4 [pii] AID - 1523 [pii] AID - 10.1186/s13023-020-01523-4 [doi] PST - epublish SO - Orphanet J Rare Dis. 2020 Sep 23;15(1):260. doi: 10.1186/s13023-020-01523-4.