Symbicort (Budesonide/Formoterol) is Associated with Lower Hospital Readmission Rates for Chronic Obstructive Pulmonary Disease (COPD) Patients at AdventHealth Orlando based on Real World Evidence Study of Medicare Claims Data

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In Symbicort, Chronic Obstructive Pulmonary Disease (COPD)

By: Sara Riascos  Mar. 28, 2022

Background:

Chronic obstructive pulmonary disease (COPD) is frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payers such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Symbicort (Budesonide/Formoterol) Symbicort (Budesonide / Formoterol) is an inhaled glucocorticoid and long acting beta-2-agonist. Studies have shown that the use of Symbicort (Budesonide / Formoterol) minimizes the risk of readmission compared to other treatments for Chronic obstructive pulmonary disease (COPD). Other studies have shown the use of Symbicort (Budesonide/Formoterol) reduces the annual rate and severity of exacerbations caused by Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD).

Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of Symbicort (Budesonide/Formoterol) within 7 days of hospitalization was associated with lower hospital readmission rates for Chronic obstructive pulmonary disease (COPD) Patients at Florida Hospital Orlando in Orlando, Florida. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real-World Evidence from Medicare Claims data, for hospitalizations at AdventHealth Orlando between January 2017 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Chronic obstructive pulmonary disease (COPD) related codes (Listed in table below)
2. Stratified Selected population into cohorts
   1. Chronic obstructive pulmonary disease (COPD) patients Symbicort (Budesonide/Formoterol) within 7 Days of Hospitalization using Part D drugs claims database
   2. Chronic obstructive pulmonary disease (COPD) patients not dispensed with Symbicort (Budesonide/Formoterol) within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Symbicort (Budesonide/Formoterol) was associated with lower hospital readmission rates for all Primary ICD Diagnosis Codes examined at AdventHealth Orlando. For patients whose primary ICD Diagnosis was “Chronic obstructive pulmonary disease with (acute) exacerbation”(J441) and when Symbicort (Budesonide/Formoterol) was used within 7 days of hospitalization, the readmission rate was 21.82% compared to the cohort where Symbicort (Budesonide/Formoterol) was not used, whose readmission rate was 23.40%. The readmission odds ratio for these cohorts was 0.91. The use of Symbicort (Budesonide/Formoterol) was associated with a 9% lower readmission rate when used within 7 days of hospitalization. The full list of studied ICD codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Symbicort (Budesonide/Formoterol) at Florida Hospital Orlando is shown below.

Primary ICD Diagnosis Code	Primary ICD Diagnosis Code Description	Total Hospitalizations without Symbicort (Budesonide/Formoterol)e	Readmission Without Symbicort (Budesonide/Formoterol)e	Readmission Rate without Symbicort (Budesonide/Formoterol)e	Total Hospitalizations with Symbicort (Budesonide/Formoterol)e	Readmission with Symbicort (Budesonide/Formoterol)e	Readmission Rate with Symbicort (Budesonide/Formoterol)e	Readmission Odds Ratio	Reduction in Readmission with Symbicort (Budesonide/Formoterol)e (%)	Confidence Interval (-)	Confidence Intervals (+)
J441	Chronic obstructive pulmonary disease with (acute) exacerbation	1,359

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Chronic obstructive pulmonary disease (COPD) were not prescribed Symbicort (Budesonide/Formoterol) within 7 days of discharge.

ICD CODE	Hospital	Hospitalizations with COPD	% of Hospitalizations without Symbicort
J441	AdventHealth Orlando	1,371	99.12%
	Emory University Hospital	929	98.82%
	Eisenhower Medical Center	624	98.08%

​Hospitalizations with Chronic obstructive pulmonary disease (COPD) = Above Listed ICD Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real-World Evidence of Medicare Claims data, for hospitalizations between January January 2017 to September 2019, the use of Symbicort (Budesonide/Formoterol) within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Chronic obstructive pulmonary disease (COPD) patients at AdventHealth Orlando. This analysis shows that a significant number of Patients are not dispensed Symbicort (Budesonide/Formoterol) after Chronic obstructive pulmonary disease (COPD) hospitalizations at AdventHealth Orlandoor major US Hospitals.