Frequency, Duration, and Cost of Pulmonary Exacerbations Among Patients With Bronchiectasis

Authors

Maitreyee Mohanty
Claudia Leiras
Haiyan Sun
Reina Rau
John Fastenau
Joseph Feliciano
Sunjay R Devarajan

Language

English

Publication Date

12-1-2025

Journal

Journal of Medical Economics

DOI

10.1080/13696998.2025.2567761

PMID

41017477

Abstract

Background: In administrative claims database studies of bronchiectasis, pulmonary exacerbations are usually defined using a fixed period for their start and end, which prevents assessment of exacerbation duration and thereby limits assessment of exacerbation characteristics. Here, we applied a novel cost-based algorithm to characterize exacerbations.

Methods: This cohort study used the Merative MarketScan Commercial Claims and Encounters database, 1-Jan-2016 to 31-Dec-2022. Patients ≥18 years with bronchiectasis (≥2 outpatient or ≥1 inpatient claim with bronchiectasis; no cystic fibrosis) had 12 months of continuous enrollment before (baseline) and ≥12 months after (follow-up) index (first bronchiectasis claim). Cost-based exacerbations were identified by compound score of week with highest percentage all-cause cost increase during follow-up compared with baseline weekly maintenance all-cause cost, and week with highest absolute weekly cost during follow-up. Exacerbation duration was the period with significantly higher weekly cost difference during follow-up than mean baseline weekly cost. Cost-based exacerbations were compared with exacerbations identified using a traditional claims-based definition.

Results: Of 9,005 patients with bronchiectasis, 6,033 had 49,750 cost-based exacerbations during 2.5 years median follow-up. Mean (SD) cost-based exacerbation duration was 3.4 (8.6) weeks (median [Q1, Q3] 1 [1, 3] weeks). During follow-up, 82.8% patients had ≥3 cost-based exacerbations, and 67.5% patients needed hospitalization/intravenous antibiotic treatment for an exacerbation. Mean respiratory costs were higher for the first cost-based exacerbation ($7,738) than the second ($5,429). Annual respiratory costs were $14,116 for patients with (vs. $3,390 without) cost-based exacerbations. Overall, 95.7% patients with cost-based exacerbations had ≥1 claims-based exacerbation; 51.0% cost-based exacerbations met the claims-based definition.

Limitations: Cost-based exacerbations may not represent true exacerbations, because cost increases could also result from worsening comorbidities or other clinical events.

Conclusions: Exacerbations identified using a cost-based algorithm frequently lasted >3 weeks. Patients with cost-based exacerbations had higher healthcare costs, particularly respiratory costs, than those without.

Keywords

Humans, Bronchiectasis, Male, Female, Middle Aged, Insurance Claim Review, Aged, Disease Progression, Adult, Algorithms, Time Factors, Health Expenditures, Hospitalization, Bronchiectasis, I10, I11, claims, cost, duration, exacerbation, frequency, real-world

Published Open-Access

yes

Recommended Citation

Mohanty, Maitreyee; Leiras, Claudia; Sun, Haiyan; et al., "Frequency, Duration, and Cost of Pulmonary Exacerbations Among Patients With Bronchiectasis" (2025). Faculty and Staff Publications. 4771.
https://digitalcommons.library.tmc.edu/baylor_docs/4771