B24-02 Real-world Effectiveness of Budesonide/Glycopyrrolate/Formoterol Fumarate on COPD Exacerbations and Healthcare Costs by Eosinophil Level: Results From the U.S. ARCTOS Study

Abstract Rationale Real-world evidence supports the benefits of COPD maintenance treatment with triple therapy, including single-inhaler budesonide/glycopyrrolate/formoterol fumarate (BGF), however limited data exist on how outcomes vary by patient blood eosinophil levels—a potential biomarker for treatment response and exacerbation risk. This study assessed changes in COPD exacerbations, healthcare resource utilization (HCRU), and costs following BGF initiation stratified by patient blood eosinophil level amongst GOLD E patients. Methods This retrospective database analysis utilized the 100% Medicare Fee-for-Service and Inovalon MORE2 Registry® of closed claims spanning 1/1/2021-3/31/2024. Inclusion criteria included: 1) prescription claim for BGF and ≥1 refill (earliest prescription claim=index date) ; 2) 12 months of health plan enrollment preceding (baseline) and following (follow-up) index; 3) ≥1 inpatient or ≥ 2 outpatient claims with diagnosis of COPD during study period; 4) age 40+ years on index; 5) absence of cancer and other select respiratory diseases; and 6) presence of ≥ 1 severe or ≥ 2 moderate COPD exacerbations during baseline. Moderate and severe exacerbations were identified using published algorithms, and COPD exacerbation-related HCRU and costs were calculated based on claims during an exacerbation period (length of hospital stay for severe; length of treatment for moderate). Patients were stratified by blood eosinophil levels; the percent change in COPD exacerbations, HCRU, and costs were assessed from baseline to follow-up. Results 393 patients with COPD treated with BGF and with available blood eosinophil data were included (17. 8% of the ARCTOS study). Mean±SD age was 68. 7±10. 5 years; 64. 6% female, 77. 9% White. Blood eosinophil cohorts were as follows: n = 70 (17. 8%) 100 cells/µL; n = 184 (46. 8%) 100-300 cells/µL; n = 139 (35. 4%) ≥300 cells/µL. Among patients with eosinophils ≥100 cells/µL (82. 2%), the annual rate of total, moderate, and severe COPD exacerbations decreased 28. 7%, 27. 7%, and 40. 0%, respectively, following BGF initiation (Table). Similar trends were observed across other eosinophil subgroups, including reductions in severe exacerbations of 50. 0% for patients with eosinophil counts ≥300 cells/µL. Mean severe exacerbation-related hospital-based costs decreased 39. 2% following BGF initiation among patients with eosinophil counts ≥100 cells/µL (2, 746 vs 1, 670, P 0. 05). Across cohorts, ∼90% of patients experienced no severe exacerbation following BGF initiation. Conclusions Patients with COPD treated with BGF demonstrated meaningful reductions in COPD exacerbations, HCRU, and costs in a real-world setting across different baseline eosinophil levels. BGF is an effective option to reduce exacerbations and healthcare costs, and can potentially inform clinical guidelines and future research. Results align with findings across eosinophil levels from the ETHOS trial. This abstract is funded by: AstraZeneca