Impact of a Health Management Program on Healthcare Outcomes among Patients on Augmentation Therapy for Alpha 1-Antitrypsin Deficiency: An Insurance Claims Analysis.
INTRODUCTION
Alpha 1-antitrypsin deficiency (AATD) is a genetic disorder which reduces serum alpha 1-antitrypsin (AAT or alpha1-proteinase inhibitor, A1PI) and increases the risk of chronic obstructive pulmonary disease (COPD). Management strategies include intravenous A1PI augmentation, and, in some cases, a health management program (Prolastin Direct®; PD).


OBJECTIVES
This study compared clinical and economic outcomes between patients with and without PD program participation.


METHODS
This retrospective study included commercial and Medicare Advantage health insurance plan members with ≥ 1 claim with diagnosis codes for COPD and ≥ 1 medical or pharmacy claim including A1PI (on index date). Outcomes were compared between patients receiving only Prolastin® or Prolastin®-C (PD cohort) and patients who received a different brand without PD (Comparator cohort). Demographic and clinical characteristics were captured during 6 months pre-index. Post-index exacerbation episodes and healthcare utilization and costs were compared between cohorts.


RESULTS
The study sample comprised 445 patients (n = 213 in PD cohort; n = 232 in Comparator cohort), with a mean age 55.5 years, 50.8% male, and 78.9% commercially insured. The average follow-up was 822 days (2.25 years), and the average time on A1PI was 747 days (2.04 years). Few differences were observed in demographic or clinical characteristics. Adjusting for differences in patient characteristics, the rate of severe exacerbation episodes was reduced by 36.1% in the PD cohort. Adjusted total annual all-cause costs were 11.4% lower, and adjusted mean respiratory-related costs were 10.6% lower in the PD cohort than the Comparator cohort. Annual savings in all-cause total costs in the PD cohort relative to the Comparator cohort was US$25,529 per patient, largely due to significantly fewer and shorter hospitalizations.


CONCLUSIONS
These results suggest that comprehensive health management services may improve both clinical and economic outcomes among patients with COPD and AATD who receive augmentation therapy.


FUNDING
Grifols Shared Services of North America, Inc.
['Campos|Michael A|MA|', 'Runken|Michael C|MC|', 'Davis|Angela M|AM|', 'Johnson|Michael P|MP|', 'Stone|Glenda A|GA|', 'Buikema|Ami R|AR|']
D000368:Aged D015331:Cohort Studies D003362:Cost-Benefit Analysis D003365:Costs and Cost Analysis D019468:Disease Management D005260:Female D006760:Hospitalization D006801:Humans D007345:Insurance Claim Review D008297:Male D008875:Middle Aged D010353:Patient Education as Topic D029424:Pulmonary Disease, Chronic Obstructive D012189:Retrospective Studies D014361:Trypsin Inhibitors D000515:alpha 1-Antitrypsin D019896:alpha 1-Antitrypsin Deficiency
Alpha 1-antitrypsin deficiency Alpha1-proteinase inhibitor Chronic obstructive pulmonary disease Pulmonary A1PI augmentation therapy Disease management programs Respiratory