P109: Expanded Utilization Metrics for COPD Value Assessment: A Scoping Review and Proposed Framework Using Claims Data
Poster Presenter
Taraneh Mousavi
PhD Student
University of Maryland, Baltimore United States
Objectives
The study objective was to propose expanded metrics for chronic obstructive pulmonary disease (COPD) that can be measured using commonly available healthcare and pharmacy claims data to quantify treatment complexity, healthcare utilization, exacerbation burden, and economic impact.
Method
A scoping review was conducted to identify metrics that can be used to measure COPD outcomes. Peer-reviewed studies were identified, screened, and categorized. Metrics were compared to available claims data variables and known value elements for COPD patients.
Results
This study synthesized evidence on priorities for individuals living with COPD identified from recent published work. These priorities were categorized as the following value elements: adherence, exacerbation burden, healthcare utilization, and economic burden. Second, we identified data elements frequently available in healthcare and pharmacy claims data. Finally, we adapted metrics found in the literature to the COPD setting, proposing specific metrics that align with the identified value elements. Overall, we identified 14 defined claims-derived metrics that extend beyond conventional measures, offering an assessment of COPD care that is related to patients’ value element. These include: 1) Treatment Complexity Score; 2) Therapy Persistence Metric; 3) COPD Outpatient-to-Inpatient Utilization Ratio; 4) Intensive Care Unit (ICU) Dependency Rate; 5) Hospitalization Duration Trend; 6) COPD Stability Interval; 7) Outpatient Care Regularity; 8) Healthcare Setting Transition Frequency; 9) Economic Burden Index; 10) Cost per Exacerbation-Free Day; 11) Severe Exacerbation Cost Multiplier; 12) Exacerbation Intensity Index; 13) Exacerbation Recovery Efficiency; and, 14) ICU Admission Predictability.
Treatment Complexity Score and Therapy Persistence Metric measure adherence, medication use pattern, and prescription adjustments over time. COPD Outpatient-to-Inpatient Utilization Ratio, ICU Dependency Rate, Hospitalization Duration Trend, COPD Stability Interval, Outpatient Care Regularity, and Healthcare Setting Transition Frequency characterize different elements related to healthcare utilization. Economic Burden Index, Cost per Exacerbation-Free Day, and Severe Exacerbation Cost Multiplier can be used by researchers to capture COPD economic burden on both patients and the healthcare system in real-world.
Conclusion
The introduction of expanded claims-based utilization metrics that aggregates the broad-based measure into a single measure presents an opportunity to enhance the assessment of COPD treatment value beyond conventional measures. By incorporating the proposed metrics into COPD studies, researchers, healthcare providers, and decision makers can gain a comprehensive understanding of real-world COPD management, particularly key aspects of economic burden, disease stability, treatment complexity and healthcare utilization.
While some of these metrics have not been directly applied in previous COPD research, existing literature suggests their potential application in assessing COPD management. Future research should focus on validating these synthesized metrics through conducting systematic reviews and structured consensus methods, such as Delphi methodology, to refine definitions and establish reliability. Additionally, as Centers for Medicare and Medicaid Services (CMS) Inflation Reduction Act (IRA) price negotiations emphasize real-world evidence, these metrics could provide essential data for cost-effectiveness evaluations, shaping Medicare pricing strategies and reimbursement models.
Developing a validated framework will not only strengthen comparative effectiveness research but also optimize COPD treatment strategies and improve real-world decision-making in healthcare resource allocation. Incorporating these refined metrics into future studies will further enhance evidence-based prescription decisions, support value-based care strategies, and ultimately contribute to more effective, patient-centered COPD management.
