A 4-Year Retrospective Claims Analysis of Oral Corticosteroid Use and Health Conditions in Newly Diagnosed Medicare FFS Patients with COPD

Abstract

We analyzed population-level administrative claims data for Medicare fee-for-service (FFS) beneficiaries to provide insights on systemic oral corticosteroid (OCS) use patterns and associated health conditions and acute events among patients newly diagnosed with chronic obstructive pulmonary disease (COPD). Background: COPD is a progressive inflammatory disease of the lungs, characterized by acute exacerbations that may lead to increased mortality. Short courses of systemic corticosteroids (SCS) are recommended to reduce recovery time from exacerbations, although SCS use has been associated with increased risk of adverse events. Methods: This study used 2013-2019 Medicare 100% FFS research identifiable files, which contain all Medicare Parts A, B, and D paid claims incurred by 100% of Medicare FFS beneficiaries. Descriptive statistics for patients newly diagnosed with COPD were analyzed, including OCS use, select health conditions and acute events, and COPD exacerbations. Statistical models were used to analyze the relationship between the incidence of select health conditions and events and cumulative OCS dosage. Results: Of Medicare FFS patients newly diagnosed with COPD, 36% received OCS in the 48 months following diagnosis, and 38% of OCS episodes lasted longer than the recommended 5-7 days. Patients had a variety of health conditions or acute events in the 24month period prior to new COPD diagnosis, such as hypertension, depression/anxiety, type 2 diabetes, or osteoporosis, that could heighten the risks of OCS use. Patients treated with >1000 mg of prednisolone equivalent OCS in the 48 months following COPD diagnosis had a higher incidence of new conditions or events, including cardiovascular disease, heart failure, hypertension, obesity, dyspepsia, infections, and depression/anxiety, than patients with no OCS use. Conclusion: These results highlight the potential risks of OCS in COPD treatment, including prolonged use among complex Medicare patients, and reinforce the importance of preventive treatment strategies and therapy optimization early in the disease course.

Secondary Fracture Rate After Vertebral Osteoporotic Compression Fracture Is Decreased by Anti-Osteoporotic Medication but Not Increased by Cement Augmentation

“…Recently, the American Society for Bone and Mineral Research (ASBMR) proposed guidelines for routine medical treatment following hip and spinal fractures in postmenopausal women, in which they recommend that all patients ≥65 years old with a vertebral fracture be offered anti-osteoporotic medications 13 . Unfortunately, only 7.8% of the patients in the present study were prescribed anti-osteoporotic medications, which aligns with previous reports of osteoporosis treatment rates following fragility fractures 2 . Barton et al found a 7% rate of treatment with antiresorptive medications following a vertebral OCF in their retrospective review of 2,933 patients 3 .…”

“…They comprise 27% of all osteoporotic fractures and are the most common osteoporotic fracture among the aging population 1 . In 2015, Medicare spent $658 million on vertebral OCFs, which had an incidence of 102.1 per 10,000 Medicare beneficiaries and a 1-year mortality rate of 21% 2 . The risk of secondary fracture within 12 months of the index event was 15% among these patients 2 .…”

“…In 2015, Medicare spent $658 million on vertebral OCFs, which had an incidence of 102.1 per 10,000 Medicare beneficiaries and a 1-year mortality rate of 21% 2 . The risk of secondary fracture within 12 months of the index event was 15% among these patients 2 . Barton et al found that 38% of patients with vertebral fracture had secondary fracture within 2 years 3 .…”

Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI

“…10 Another study using Medicare claims data from 2013 to 2019 found that 36% of patients newly diagnosed with COPD received OCS in the 48 months following diagnosis, lasting longer than 5–7 days for 38% of episodes. 11 …”

Exacerbations Predict Severe Cardiovascular Events in Patients with COPD and Stable Cardiovascular Disease–A Nationwide, Population-Based Cohort Study

“…[18][19][20] Short courses of oral corticosteroids at a daily dose of 40 mg prednisolone equivalent for 5-7 days are routine in the treatment of acute exacerbations. However, Bazell et al 21 have shown that treatment with daily doses of over 1000 mg prednisolone equivalent was associated with a higher incidence of events that may be OCS-related, including CVD and heart failure. While we lack data on the total accumulated OCS doses, it is possible that patients in our study receiving large doses of steroids to treat acute COPD could have contributed to our results.…”