Health care resource utilization (HCRU) in early and late diagnosed Chronic Obstructive Pulmonary Disease (COPD) patients in UK primary care

Background: Previous studies have shown that opportunities to diagnose COPD at an early stage were missed in ~85% of patients. We investigated the HCRU between patients with early vs. late diagnosis of COPD. Methods: Newly diagnosed COPD patients were identified in UK Clinical Practice Research Database from 2011 to 2014. All patients were required to have a minimum of practice data of 5 years before and 1 year after their diagnosis. Patients entered into a late-diagnosed (late) cohort if ≥3 of eight indicators of early COPD presence were found in reviewing their 5-year pre-diagnosis medical data. Others formed an early diagnosis (early) cohort. We examined characteristics of the two cohorts at baseline and their HCRU (COPD related clinical visits, Accident & Emergency (A&E) visits, and hospitalisations) in 1, 2 and 3 years of follow up after diagnosis, respectively. Results: There were 3,375 (33%) early diagnosed vs 6,783 (67%) late diagnosed patients. Baseline characteristics were comparable between two cohorts. The late cohort had a rate of COPD hospitalisations (per 1,000 patient years) higher than the early one (50.4 vs 37.8 in 1 year, 63.1 vs 44.5 in 2 years, and 73.2 vs 50.46 in 3 years). The difference was statistically significant in the 2-year and 3-year periods in the adjusted negative binomial regression model. The rate of A&E visits was numerically higher in the late cohort. No significant difference was observed in the rate of clinical visits. Conclusion: A significant percentage of COPD patients in UK primary care are diagnosed late. Late diagnosis is associated with higher rate of COPD-related hospitalisations.