Exacerbations and Healthcare Burden of COPD with Type 2 Inflammation: US Claims Analysis.

BACKGROUND: Up to 40% of patients with chronic obstructive pulmonary disease (COPD) have type 2 inflammation, characterized by an elevated blood eosinophil count (BEC), with limited real-world evidence of disease burden. METHODS: Retrospective analysis using Optum's Clinformatics® Data Mart Database, covering over 28 million lives of de-identified medical and pharmacy claims data in the US (commercial insurance and Medicare Advantage). Eligible patients required ≥2 COPD diagnosis claims (≥30 days apart) from January 2021 to December 2023, ≥40 years old at index date (last COPD diagnosis claim), continuous insurance coverage for ≥12 months both before (baseline) and after (follow-up) index date, triple therapy for ≥1 day and eligible BEC (≥14 days since last systemic corticosteroid use, if applicable) at baseline. Patients were categorized into three groups: with ≥2 moderate or ≥1 severe exacerbations (EXAC) and BEC ≥150 or ≥300 cells/µL at baseline ("EXAC-EP-150" and "EXAC-EP-300", respectively), and a reference group (BEC ≥150 cells/µL but not EXAC). Outcomes included COPD-related exacerbations, healthcare resource utilization (HCRU) and medical costs. RESULTS: There were 13,840 eligible patients (6,389 EXAC-EP-150; 3,100 EXAC-EP-300; 7,451 reference). During 12-month follow-up, the mean (95% confidence interval) rates of any COPD-related exacerbations were similar in the EXAC-EP-150 and EXAC-EP-300 groups, both higher versus the reference group (1.58 [1.53, 1.63] and 1.56 [1.50, 1.63] vs 0.52 [0.50, 0.54]). Similarly, COPD-related HCRU and medical costs were higher in the EXAC-EP-150/300 groups than the reference group. CONCLUSION: Patients with COPD and type 2 inflammation experiencing exacerbations despite triple therapy have high exacerbation rates, HCRU, and medical costs, highlighting the need for improved management of this patient population.