Introduction: Oral corticosteroids (OCS) are used to manage chronic obstructive pulmonary disease (COPD) exacerbations but are associated with adverse outcomes that may increase healthcare resource utilization and costs. We compared attendance/costs associated with OCS-related adverse outcomes in patients who ever used OCS versus those who never used OCS and examined associations between cumulative OCS exposure and attendance/costs.
Methods: This direct matched observational cohort study used the UK Clinical Practice Research Datalink GOLD database (data range 1987-2019). Patients with a COPD diagnosis on/after April 1, 2003, and Hospital Episode Statistics linkage were included. Emergency room, specialist or primary care outpatient, and inpatient attendance were analyzed. Costs, estimated using Health and Social Care 2019 and National Health Service Reference Costs 2019-2020 reports, were adjusted for sex, age, exacerbation number, and inhaler type used in the 12 months before index date.
Results: The OCS cohort had higher annualized disease-specific (excluding respiratory) total attendance/costs versus the non-OCS cohort (adjusted incidence rate ratio [aIRR] with 95% confidence intervals [CIs]) ranging from 37% (1.37 [1.31, 1.43]) for emergency room attendances to 149% (2.49 [2.36, 2.63]) for specialist consultations. Disease-specific (excluding respiratory) attendance/costs increased in a positive dose-response relationship for most attendance categories versus the < 0.5 g reference dose. For the 0.5 to < 1.0 g cumulative dose category, the greatest increases in disease-specific (excluding respiratory) attendance/costs occurred for primary care consultations (aIRR [95% CI] 1.38 [1.32, 1.44]). For the ≥ 10 g cumulative dose category, the greatest increases were observed for primary care consultations (aIRR [95% CI] 2.83 [2.66, 3.00]), non-elective long stays (≥ 2 days; 2.54 [2.15, 2.99]), and non-elective short stays (≤ 1 day; 2.51 [2.12, 2.98]). Similar findings were observed for all-cause attendance/costs.
Conclusion: Among patients with COPD, OCS-related adverse outcomes were associated with higher attendance and costs, with a positive dose-response relationship. A graphical abstract is available with this article.
Keywords: Chronic obstructive pulmonary disease; Cohort study; Corticosteroids; Cost; Healthcare resource utilization; Observational; Primary care.
Many people living with chronic obstructive pulmonary disease (COPD) have “flare-ups”, or exacerbations, at which time their symptoms suddenly worsen. To treat exacerbations, doctors may prescribe steroid tablets (oral corticosteroids or OCS for short). However, repeated OCS use may have negative health effects, leading to increased hospital visits or stays and higher healthcare systems costs. Using anonymized patient records from England, we compared attendance and associated costs to the healthcare system related to the negative health effects of OCS use for planned (elective) and non-planned (non-elective) hospital stays, emergency room visits, and primary care and specialist appointments in patients who have ever used OCS versus patients who have never used OCS. We also explored how the amount of OCS used by patients related to their attendance and costs. Patients were grouped into 53,299 pairs so every patient who ever used OCS was matched to one who never used OCS (e.g., those with the same age and sex), and their treatment and attendance was followed over approximately 6 years. We found that patients who received OCS had higher attendance and costs than those who did not, ranging from 37% higher for emergency room visits to 149% higher for specialist appointments. In patients who used OCS, costs were generally greater when more OCS was used, with the greatest increases observed for primary care appointments. These results show that the negative health effects of OCS lead to increased burden and healthcare costs in people living with COPD, with higher use incurring greater costs.
© 2024. The Author(s).