title: COPD exacerbations associated with the modified Medical Research Council scale and COPD assessment test among Humana Medicare members.
abstract: BACKGROUND
  The Global initiative for chronic Obstructive Lung Disease guidelines recommend assessment of COPD severity, which includes symptomatology using the modified Medical Research Council (mMRC) or COPD assessment test (CAT) score in addition to the degree of airflow obstruction and exacerbation history. While there is great interest in incorporating symptomatology, little is known about how patient reported symptoms are associated with future exacerbations and exacerbation-related costs.
  
  
  METHODS
  The mMRC and CAT were mailed to a randomly selected sample of 4,000 Medicare members aged >40 years, diagnosed with COPD (≥2 encounters with International Classification of Dis eases-9th Edition Clinical Modification: 491.xx, 492.xx, 496.xx, ≥30 days apart). The exacerbations and exacerbation-related costs were collected from claims data during 365-day post-survey after exclusion of members lost to follow-up or with cancer, organ transplant, or pregnancy. A logistic regression model estimated the predictive value of exacerbation history and symptomatology on exacerbations during follow-up, and a generalized linear model with log link and gamma distribution estimated the predictive value of exacerbation history and symptomatology on exacerbation-related costs.
  
  
  RESULTS
  Among a total of 1,159 members who returned the survey, a 66% (765) completion rate was observed. Mean (standard deviation) age among survey completers was 72.0 (8.3), 53.7% female and 91.2% white. Odds ratios for having post-index exacerbations were 3.06, 4.55, and 16.28 times for members with 1, 2, and ≥3 pre-index exacerbations, respectively, relative to members with 0 pre-index exacerbations (P<0.001 for all). The odds ratio for high vs low symptoms using CAT was 2.51 (P<0.001). Similarly, exacerbation-related costs were 73% higher with each incremental pre-index exacerbation, and over four fold higher for high-vs low-symptom patients using CAT (each P<0.001). The symptoms using mMRC were not statistically significant in either model (P>0.10).
  
  
  CONCLUSIONS
  The patient-reported symptoms contribute important information related to future COPD exacerbations and exacerbation-related costs beyond that explained by exacerbation history.
authors.affiliation: Comprehensive Health Insights, Inc., Humana Inc., Louisville, KY.
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Pasquale
authors.affiliation: Comprehensive Health Insights, Inc., Humana Inc., Louisville, KY.
authors.forename: Yihua
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Outcomes and Evidence, Global Health & Value, Pfizer Inc., New York, NY.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Baker
authors.affiliation: Statistical Center for Outcomes, Real-World and Aggregate Data, Global Innovative Pharma Business, Pfizer Inc., New York, NY.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Zou
authors.affiliation: Global Medical Development, Global Innovative Pharma Business, Pfizer Inc., Groton, CT, KY.
authors.forename: John G
authors.initials: JG
authors.lastname: Teeter
authors.affiliation: Retail Strategy & Execution, Humana Inc., Louisville, KY.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Renda
authors.affiliation: Comprehensive Health Insights, Inc., Humana Inc., Louisville, KY.
authors.forename: Cralen C
authors.initials: CC
authors.lastname: Davis
authors.affiliation: Global Medical Affairs, Global Innovative Pharma Business, Pfizer Inc., New York, NY, USA.
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Outcomes and Evidence, Global Health & Value, Pfizer Inc., New York, NY.
authors.forename: Joel
authors.initials: J
authors.lastname: Bobula
mesh_terms: D000368:Aged; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology; D012129:Respiratory Function Tests / Q000379:methods; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000379:methods*; D000067251:Symptom Flare Up; D014481:United States / Q000453:epidemiology
keywords: COPD symptomatology; Global initiative for chronic Obstructive Lung Disease; exacerbation-related cost; exacerbations; survey data
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