GSK and Innoviva’s Trelegy Ellipta could Impact Readmissions: Huntsville Hospital Readmission Rates with COPD
In Trelegy, Chronic Obstructive Pulmonary Disease (COPD)
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By: Jeffrey Maser Mar. 23, 2018
In September of 2017, GlaxoSmithKline and Innoviva, Inc. released Trelegy Ellipta, a once-daily inhaler therapy for chronic obstructive pulmonary disease (COPD). The inhaler triple-therapy is the first in the U.S. that combines three active molecules, fluticasone furoate (FF), umeclidinium (UMEC) and vilanterol (VI), in a single inhaler for the treatment of eligible COPD patients. FF is classified as an inhaled corticosteroid (ICS), VI is a long-acting β2 agonist (LABA) and UMEC is a long-acting muscarinic receptor antagonist (LAMA). Research from the Gold Initiative for Chronic Obstructive Lung Disease shows that the combination of an ICS, LABA, and LAMA is effective in treatment for group D COPD patients, a subset of patients with COPD who are more symptomatic and at higher risk for exacerbations. The combination of these three molecules in one product could be of further benefit as well, since patient compliance is boosted by the need to take fewer medications.
Dexur analysts examined Medicare inpatient discharges (excluding discharges where the patient was transferred, discharged against medical advice or expired) at Huntsville Hospital in Huntsville, Alabama. Huntsville Hospital is the highest volume hospital in Alabama and one of the highest volume hospitals for COPD in the United States. Dexur’s analysis indicates that there were 15,280 discharges (24.51%) with COPD among the 62,347 total inpatient discharges at the hospital between 2013-2016. Additionally, 4.99% of all inpatient discharges had a readmission with COPD during the four year period. However, discharges for certain therapeutic areas and conditions experienced significantly more readmissions with COPD compared to others.
As could be expected, pulmonology discharges had the highest readmission rate with COPD at 11.91%. Of these discharges, DRG-190, which represents COPD with major complication or comorbidity, had the highest readmission rate at 19.57%. DRG-191, COPD with complication or comorbidity, had the 2nd highest rate at 17.89%. However, a non-COPD diagnosis related group, DRG-189 (Pulmonary Edema And Respiratory Failure), had the 3rd highest rate at 16.71%. DRG-192, which refers to COPD without complication or comorbidity, had a readmission rate of 11.99%, on par with multiple non-COPD DRGs within the pulmonary discipline. This suggests that while COPD discharges with complications or comorbidities may be at greater risk for a COPD readmission than all other discharges, COPD discharges without complications or comorbidities are just as likely to have a COPD readmission as numerous non-COPD pulmonary discharges. With such a high count of COPD discharges and readmissions at large, high volume hospitals such as Huntsville Hospital, it is clear that advancements in COPD care could greatly improve hospital quality and cost outcomes.
| 30-Day Readmission Rates with COPD by Pulmonology DRG at Huntsville Hospital (January 2013 - December 2016) | |
|---|---|
| Diagnosis Related Group | 30-Day COPD Readmission Rate (%) |
| Pulmonology | 11.91 |
| DRG-193: Simple Pneumonia And Pleurisy With Major Complication or Comorbidity | 11.13 |
| DRG-177: Respiratory Infections And Inflammations With Major Complication or Comorbidity | 11.32 |
| DRG-178: Respiratory Infections And Inflammations With Complication or Comorbidity | 11.82 |
| DRG-192: Chronic Obstructive Pulmonary Disease Without Complication or Comorbidity/Major Complication or Comorbidity | 11.99 |
| DRG-208: Respiratory System Diagnosis With Ventilator Support <96 Hours | 15.83 |
| DRG-189: Pulmonary Edema And Respiratory Failure | 16.71 |
| DRG-191: Chronic Obstructive Pulmonary Disease With Complication or Comorbidity | 17.89 |
| DRG-190: Chronic Obstructive Pulmonary Disease With Major Complication or Comorbidity | 19.57 |
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- Huntsville Hospital Discharge Volume, Huntsville Hospital 30-Day COPD Readmissions, Huntsville Hospital 30-Day COPD Readmission Rate, Alabama 30-Day COPD Readmission Rate and National 30-Day COPD Readmission Rate by Pulmonology DRG between January 2013 - December 2016
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