Eosinophil counts in first COPD hospitalizations: a 1-year cost analysis in Quebec, Canada

Thomas G Poder1–3 Nathalie Carrier,1 Maryse Bélanger,1,4 Simon Couillard,1,4 Josiane Courteau,1 Pierre Larivée,1,4 Alain Vanasse1,3 1Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada; 2Health Technology Assessment Unit, UETMIS, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada; 3Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; 4Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Background: Exacerbations explain much of the cost of COPD. Higher blood eosinophil cell counts at admission for acute exacerbation of COPD increase the risk of subsequent exacerbations and hospitalizations. However, there is no literature on the economic burden of patients with this inflammatory profile. The objective of this study is to assess the cost of health-care service utilization according to different counts of blood eosinophils.Methods: The observational retrospective cohort included all first hospitalizations for COPD exacerbation between April 2006 and March 2013. The eosinophilic group was defined by blood eosinophil counts on admission ≥200 cells/µL and/or ≥2% of the total white blood cell count. Study outcomes were: total costs (2016 Canadian dollars) (index hospitalization and 1-year follow-up), total index hospitalization costs, total 1-year costs (all-cause readmissions, ambulatory and emergency service use), and 1-year COPD-related costs (only cost for COPD after initial discharge). Sensitivity analyses were conducted to evaluate the impact of different eosinophil cut-offs on outcomes.Results: In total, 479 patients were included, 173 in the eosinophilic group (92 in the higher cut-off). The average total cost was $18,263 ($6,706 for the index hospitalization), without significant difference between groups (P=0.3). The average 1-year COPD-related cost was higher in the eosinophilic group ($3,667 vs$2,472, P=0.006), with an adjusted mean difference of 1,416. Analysis of data using the higher cut-off of ≥400 cells or ≥3% was associated with a slightly larger difference in 1-year COPD-related costs between groups (4,060 vs $2,629, P=0.003), with an adjusted mean difference of$1,640.Conclusion: A higher blood eosinophil cell count at admission for a first hospitalization is associated with an increase in total 1-year COPD-related costs. Keywords: chronic obstructive pulmonary disease, exacerbations, health-care utilization, cohort study, Canada, Quebe

Greater eosinophil counts at first COPD hospitalization are associated with more readmissions and fewer deaths

Qing Li,1 Pierre Larivée,2,3 Josiane Courteau,2 Simon Couillard,2,3 Thomas G Poder,2,4,5 Nathalie Carrier,2 Maryse Bélanger,2,3 Alain Vanasse2,5 1Center for Innovation Management Research of Xinjiang, School of Economics and Management, Xinjiang University, Urumqi, Xinjiang, China; 2Research Center, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada; 3Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; 4Health Technology Assessment Unit, UETMISSS, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada; 5Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Purpose: The impacts of high blood eosinophil count (HBEC) at admission for COPD exacerbation on posthospitalization outcomes are still unclear. Previous studies have focused on its associations with first readmission rates; yet, its impacts on longitudinal outcomes such as subsequent readmissions still have to be explored. The main objective of this study is to investigate outcomes associated with HBEC following a first hospitalization for COPD exacerbation.Patients and methods: This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5 years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the HBEC group if the blood eosinophil count at admission was ≥200 cells/µL and/or ≥2% of the total white blood cells. With information on exact dates of subsequent hospitalizations and death, we modeled readmissions and death as states in a multi-state Markov model and estimated transition probabilities to the next states. Sensitivity analyses were performed by varying thresholds for the definition of HBEC (≥300 cells/µL and/or ≥3%).Results: A total of 479 patients were included, of which 173 had HBEC. The transition probabilities for a first readmission was 74% (95% CI, 66%–83%) for patients with HBEC vs 70% (95% CI, 63%–77%) for patients with normal blood eosinophil count (NBEC). The transition probabilities for a second readmission were 91% (95% CI, 84%–100%) for HBEC patients in contrast with 83% (95% CI, 74%–92%) for NBEC patients. Meanwhile, transition probability for death was lower in patients with HBEC. The differences enlarged in sensitivity analyses with higher cutoff.Conclusion: Greater blood eosinophil cell counts during a first hospitalization for COPD predict increased susceptibility to up to two readmissions. These patients may however have a lower risk of death. Keywords: COPD, blood eosinophil cell count, exacerbations, readmissions, death, multi-state Markov model, transition probability, observational cohort study, clinical data, administrative dat

Eosinophil counts in first COPD hospitalizations: a comparison of health service utilization

Maryse Bélanger,1,2 Simon Couillard,1,2 Josiane Courteau,1 Pierre Larivée,1,2 Thomas G Poder,1,3,4 Nathalie Carrier,1 Kim Girard,1 Felix-Antoine Vézina,1,2 Alain Vanasse1,4 1Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada; 2Respirology Service, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; 3Health Technology Assessment Unit, UETMIS, CIUSSS de l’Estrie – CHUS, Sherbrooke, QC, Canada; 4Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Purpose: Current evidence suggests that a higher blood eosinophil cell count at admission for acute exacerbation of COPD (AECOPD) is associated with a favorable response to systemic steroids. However, the impact of blood eosinophil counts at admission on post-hospitalization outcomes is still unclear. The main objective of this study is to investigate readmission outcomes associated with blood eosinophilia following severe COPD exacerbation in patients with infrequent COPD hospitalizations. Patients and methods: This is an observational cohort study design. We retrospectively analyzed data of patients with a first hospitalization within 5 years for COPD exacerbation between April 2006 and March 2013. Patients were stratified into the eosinophilic group if the blood eosinophil count on admission was ≥200 cells/µL and/or ≥2% of the total white blood cell (WBC) count. The primary outcome was 1-year COPD-related readmission. Secondary outcomes included 1-year all-cause mortality, 1-year all-cause readmission, length of stay, time to COPD-related readmission, and number of 1-year COPD-associated emergency department (ED) and ambulatory visits. Results: A total of 479 patients were included. Of whom, 173 were stratified into the eosinophilic group. Higher blood eosinophil cell count was associated with an increased risk of 1-year COPD-related readmission (OR, 1.83 [95% CI, 1.16–2.89]; P<0.01), a shorter time to first COPD-related readmission (HR, 1.64 [95% CI, 1.14–2.36]; P<0.01), and an increased number of 1-year COPD-related ED visits (incidence rate ratio, 1.78 [95% CI, 1.21–2.61]; P<0.01). All-cause mortality, all-cause readmission, length of stay, and number of ambulatory visits did not differ between groups. Conclusion: Higher blood eosinophil cell count at admission for a COPD exacerbation is associated with increased COPD readmission rates in patients with infrequent COPD hospitalizations. Keywords: COPD, exacerbations, hospitalization, mortality, cohort stud

An overview of management of drug-induced hair and nail disorders

The diagnosis and management of drug-induced hair and nail disorders in the clinic presents a unique challenge for the physician. Not only must the physician recognize the trigger and manage the symptoms but also consider the influence these disorders have on the patient's quality of life. This article describes the various types of drug-induced hair and nails disorders, and discusses the clinical recognition, pathophysiology and possible management options