Clinical and Economic Outcomes in Patients With Alpha-1 Antitrypsin Deficiency in a US Medicare Advantage Population

TL;DR

This study examines health and economic outcomes of patients with Alpha-1 Antitrypsin Deficiency in the US Medicare population, finding higher healthcare use and comorbidities in those with COPD and AATD.

Contribution

The study provides new insights into clinical and economic outcomes of AATD patients in Medicare Advantage plans and tracks AATD testing rates over time.

Findings

Individuals with COPD and AATD had higher rates of emphysema, COPD exacerbations, and cirrhosis compared to those without AATD.

AATD patients had increased inpatient admissions and emergency department visits compared to non-AATD patients.

AATD testing rates among newly diagnosed COPD patients increased slightly from 2015 to 2020 but remained low.

Abstract

Alpha-1 antitrypsin deficiency (AATD) testing rates and associated clinical and economic outcomes data in the US Medicare population are limited.

To characterize individuals with AATD, describe clinical outcomes/healthcare research utilization (HCRU) among individuals with chronic obstructive pulmonary disease (COPD) with or without AATD, and identify AATD testing rates among individuals newly diagnosed with COPD.

This retrospective, observational analysis of claims data included individuals from the Humana Research Database (aged 18-89 years) enrolled in Medicare Advantage Prescription Drug plans. Three cohorts included individuals with evidence of AATD; individuals with COPD + AATD matched to individuals with COPD; and individuals with newly diagnosed COPD. AATD health-related outcomes, such as pulmonary and extrapulmonary conditions or events, and economic outcomes, including inpatient admissions, emergency department visits, and physician visits, were examined independently during the pre-index and post-index periods and compared between those with ATTD and without AATD.

We identified 1103 individuals with AATD (aged 67.2 ± 10.0 years, 56.3% women, 94.5% White); overall, 22.2% had exacerbations, respiratory distress, and respiratory failure. Individuals with COPD and AATD (n = 742) were matched to individuals with COPD (n = 7420), based on age (68 ± 9 years), sex (55.0% women), and race (97.2% White). The AATD group had a higher proportion of emphysema (47.4% vs 18.7%), COPD exacerbations (40.6% vs 24.7%), and cirrhosis (4.0% vs 1.3%) than the non−AATD group. All-cause inpatient admissions (31.7% vs 27.3%), COPD-specific inpatient admissions (7.4% vs 4.3%), and COPD-specific emergency department visits (19.5% vs 10.8%) were higher in individuals who had ATTD than in those without AATD. AATD testing rates among individuals with newly diagnosed COPD increased slightly over time (2015: 1.07%; 2020: 1.49%). Individuals with COPD and AATD had more comorbidities and higher HCRU. Testing rates increased slightly but remained low.

Further research is needed to assess the impact of improved AATD testing on those with COPD.

Increased awareness, earlier testing, and treatment may reduce the healthcare burden of AATD in the US Medicare population.

Figures