Objective

Acute exacerbations are common complications of chronic obstructive pulmonary disease (COPD) with a significant impact on patient’s quality of life. The main objectives of the study are to describe the hospital management and estimate the burden of acute exacerbations of COPD (AECOPD).

Methods

DATA EXTRACTIONSTUDY PERIODJanuary 1st, 2015 to December 31st, 2016.

DESIGNPopulation-based retrospective study of the PMSI-MCO (French National Hospital Discharge Database - Medicine, Surgery, Obstetrics) database, a comprehensive collection of all inpatient stays in France and using International Classification of Diseases, 10th Revision (ICD-10) codes.

DATA EXTRACTIONAll 2015 and 2016 hospital stays with ICD-10 codes for AECOPD were extracted. Hospitalisations for an AECOPD were defined using the validated algorithms by Santé publique France (narrow and broad definition)1. The narrow algorithm only is presented hereby.

Results

STUDY POPULATIONPatients ≥ 40 years old with at least one hospitalisation for an AECOPD.

FOLLOW-UP OF PATIENTSFor each individual, the index stay was defined as being the first hospitalization for AECOPD in 2015 or 2016. Each patient included before June 30th, 2016 was therefore followed-up for 6 months after their discharge from the index stay and additional hospitalisations for AECOPD were retrieved, according to the same algorithms.

ECONOMIC EVALUATIONFor each patient, total in-hospital medical resource consumption associated with the hospitalisations was documented. Costs were attributed from official French national tariffs and expressed in 2018 Euros.

Conclusion

This study confirms the high epidemiological and economic burden of the hospitalisations for AECOPD in France. A focus for new interventions and education should be made to decrease this level of spending in future.

de Léotoing L.1, Melloni B.2, Cavailles A.3, Flament T.4, Raguideau F.1, Jolivel R.1, Caumette D.5, Le Lay K.5, Luciani L.5

1 HEVA Sarl, Lyon, France ; 2 CHU Limoges, Limoges, France ; 3 CHU Nantes, Nantes, France ;4 CHRU Tours, Tours, France ; 5 Boehringer Ingelheim France, Paris, France

ISPOR 21th Annual European Congress,10-14 November 2018, Barcelona, Spain PRS30

1 http://invs.santepubliquefrance.fr/Dossiers-thematiques/Maladies-chroniques-et-traumatismes/Broncho-pneumopathie-chronique-obstructive-et-insuffisance-respiratoire-chronique/Surveillance-epidemiologique-de-la-broncho-pneumopathie-chronique-obstructive-et-de-l-insuffisance-respiratoire-chronique-en-France (updated March 7th, 2017; cited October 4th, 2018)

We thank Geoffrey Berthon, from CHRU Tours (France) who participated to this study.

Hospital management of acute COPD exacerbation and impact

on hospital re-admission in France

PATIENTS

YEARS OLD

PATIENTS

73.9±12.2

28,493 19.9 % ±10.1

9.1% of 143,023 6.5% of 143,023

12,998PATIENTS

PATIENTS

PATIENTS

PATIENTS

9,328during first AECOPD stay

Mean age (± SD)

Number of patients with ≥ 1 AECOPD stay

PATIENTS AND AECOPD STAY CHARACTERISTICS

PATIENTS FOLLOWED-UP ≥ 6 MONTHS

Cost of the first AECOPD rehospitalisation

62 %

38 %

men

≥ 3

2

1

0 94.1 %

2015-2016

2015

2016

143,023

80,056

80,004

3.2 %

1.3 %

1.4 %women

GenderPrevious hospitalisationfor AECOPD within 1 year before

In-hospital death within 30 days after first AECOPD stay

ICU (intensive care unit) during first AECOPD stay

DAYS10.9

Mean length of the first AECOPD stay (± SD)

PATIENTS

MEAN (± SD)Q1

116,679 81.6%of 143,023

€5,208€3,254

MIN

€566

Q3

€5,422

MAX

€151,504

± €5,069

MEDIAN

€4,340

17.7 %of 116,679PATIENTS

20,652

Patients with ≥ 1 rehospitalisationfor AECOPD within 6 monthsNumber of patients followed-up ≥ 6 months

COPD (J44.0)

Emphysema (J43)ORPD AD

lower respiratory infection (J09-J18, J20-J22)

Acute respiratory

failure (J96.0)

OR

COPD with acute infection

of airways (J44.0)

COPD with acute

non-specified episodes (J44.1)

OROR

WITH

PD

COPD (J44.0) Emphysema (J43)OR

lower respiratory infection (J09-J18, J20-J22)

PD ADAcute respiratory failure (J96.0)

AD

WITH

COPD with acute infection of airways (J44.0)

COPD with acute non-specified episodes (J44.1)

PD: Primary DiagnosisAD: Associated Diagnosis

ORPD

OR

OR

OR

COPD (J44.0) Emphysema (J43)OR

WITH

Exclusion of stays < 2 days where the patient was still alive