Frequency, duration, and cost of pulmonary exacerbations among patients with bronchiectasis

BackgroundIn administrative claims database studies of bronchiectasis, pulmonary exacerbations are usually defined using a fixed period for their start and end, which prevents assessment of exacerbation duration and thereby limits assessment of exacerbation characteristics. Here, we applied a novel cost-based algorithm to characterize exacerbations.MethodsThis cohort study used the MerativeTM MarketScan® Commercial Claims and Encounters database, 1-Jan-2016 to 31-Dec-2022. Patients ≥18 years with bronchiectasis (≥2 outpatient or ≥1 inpatient claim with bronchiectasis; no cystic fibrosis) had 12 months of continuous enrollment before (baseline) and ≥12 months after (follow-up) index (first bronchiectasis claim). Cost-based exacerbations were identified by compound score of week with highest percentage all-cause cost increase during follow-up compared with baseline weekly maintenance all-cause cost, and week with highest absolute weekly cost during follow-up. Exacerbation duration was the period with significantly higher weekly cost difference during follow-up than mean baseline weekly cost. Cost-based exacerbations were compared with exacerbations identified using a traditional claims-based definition.ResultsOf 9,005 patients with bronchiectasis, 6,033 had 49,750 cost-based exacerbations during 2.5 years median follow-up. Mean (SD) cost-based exacerbation duration was 3.4 (8.6) weeks (median [Q1, Q3] 1 [1, 3] weeks). During follow-up, 82.8% patients had ≥3 cost-based exacerbations, and 67.5% patients needed hospitalization/intravenous antibiotic treatment for an exacerbation. Mean respiratory costs were higher for the first cost-based exacerbation ($7,738) than the second ($5,429). Annual respiratory costs were $14,116 for patients with (vs $3,390 without) cost-based exacerbations. Overall, 95.7% patients with cost-based exacerbations had ≥1 claims-based exacerbation; 51.0% cost-based exacerbations met the claims-based definition.LimitationsCost-based exacerbations may not represent true exacerbations, because cost increases could also result from worsening comorbidities or other clinical events.ConclusionsExacerbations identified using a cost-based algorithm frequently lasted >3 weeks. Patients with cost-based exacerbations had higher healthcare costs, particularly respiratory costs, than those without.