Real-world disease burden, mortality, and healthcare resource utilization associated with bronchiectasis

Abstract

Objectives: To assess real-world survival and healthcare resource utilization (HCRU) in US patients with non-cystic fibrosis bronchiectasis (NCFBE).

Methods: This retrospective analysis, using data from the STATinMED RWD Insights database from Jan 2015-Oct 2022, included adults with NCFBE (from Jan 2015-Oct 2021) and non-NCFBE comparators (from Jan 2015-Aug 2020); baseline characteristics were balanced by inverse probability treatment weighting. Outcomes included survival through end of study. HCRU was assessed over 12 months.

Results: 117,718 patients with NCFBE and 306,678 comparators were included. Patients with NCFBE had a 77% higher risk of death than comparators (hazard ratio [HR] 1.77 [95% CI 1.74-1.80]). Risk of death was higher among patients aged ≥65 years (vs 18-34 years; HR 11.03 [95% CI 10.36-11.74]), among Black patients (vs White; HR 1.53 [95% CI 1.50-1.55]), and among patients with comorbid COPD (HR 1.42 [95% CI 1.40-1.44]). Patients with NCFBE incurred higher all-cause and respiratory-related HCRU than comparators for outpatient office, outpatient hospital, emergency department (ED), inpatient and respiratory-related pulmonologist visits (all p < .0001); HCRU increased with exacerbations.

Conclusions: Patients with NCFBE have high mortality burden and incur high HCRU, both of which are further increased with exacerbations. Prevention and delay of exacerbations are key areas for improvement of disease management.

Keywords: Bronchiectasis; exacerbation; healthcare resource utilization; survival.

Figure 1.

Study design. The identification periods differed between cases and comparators as the comparator cohort was previously established while the case cohort was able to utilize more recent data. The case and comparator cohorts were matched using IPTW, with a ratio of 1:2.5 patients with NCFBE to comparators, to account for potential bias. The index date was the earliest claim used to identify each patient with NCFBE during the case-identification period or a randomly assigned date for comparator patients during the comparator-identification period. IPTW, inverse probability treatment weighting; NCFBE, non-cystic fibrosis bronchiectasis.

Figure 2.

Exacerbations during 12 and 24 months of follow-up among patients with NCFBE, based on (a) exacerbations requiring oral antibiotic use or exacerbations requiring hospitalization or IV antibiotic use and (b) frequency of exacerbations. Note. groups in panel A are not mutually exclusive. IV, intravenous; NCFBE, non-cystic fibrosis bronchiectasis.