Budget impact analysis of a digital monitoring platform for COPD

Table 1 Model input parameters

Parameter	Value	Source
Population parameters, proportion of patients
Age distribution (commercial)		Current Population Survey, 2018 [19]
< 40 years	53.0%
40–64 years	35.0%
> 65 years	12.0%
Age distribution (Medicare)		Current Population Survey, 2018 [19]
< 40 years	3.0%
40–64 years	12.0%
> 65 years	85.0%
COPD prevalence		CDC [20]
40–64 years	7.6%
≥ 65 years	13.2%
COPD groups		Cabrera-Lopez et al. [21]
GOLD A	53.4%
GOLD B	26.7%
GOLD C	8.2%
GOLD D	11.7%

	GOLD A	GOLD B	GOLD C	GOLD D
Healthcare resource use parameters by GOLD category, number per patient per year
Annual medical resource use					Wallace et al. [5] and Bhatta et al. [22]
Outpatient visits	2.64	2.64	2.64	2.64
ED visits	0.11	0.19	0.22	0.22
Hospitalizations	0.36	0.46	0.56	0.56
Readmissions	0.04	0.07	0.08	0.08
Inhaled medication use parameters by GOLD category
Weekly SABA utilization, puffs/week	5.81	8.82	5.81	12.78	Gondalia et al. [7]
Proportion of patients utilizing controller medications					Internal clinical expert opinion
LAMA monotherapy	40%	30%	0%	0%
LABA monotherapy	20%	0%	0%	0%
LABA + ICS	0%	30%	60%	40%
LAMA + LABA	40%	40%	35%	10%
LABA + LAMA + ICS	0%	0%	5%	50%
PDC for controller medications	0.54	0.60	0.56	0.62	Wallace et al. [5]
Unit cost inputs, USD
Medical resource unit costs (commercial)					Wallace et al. [5] and inflated to 2020 USD using the medical care component of the CPI [23]
Office/outpatient visits		126
ED visits		3,065
Hospitalizations		25,839
Medical resource unit costs (Medicare)					Wallace et al. [5] and inflated to 2020 USD using the medical care component of the CPI (23) and converted to Medicare payments using commercial-to-Medicare payment ratios[24]
Office/outpatient visits		88
ED visits		1,161
Hospitalizations		13,671

Parameter	Value	Source
SABA medications (WAC), USD		Red Book Online, 2020 (25)
Albuterol sulfate HFA	35.98
Albuterol sulfate HFA (Cipla)	57.75
Proair Digihaler	146.67
Proair HFA	66.88
Proair Respiclick	62.52
Proventil HFA	79.73
Ventolin HFA	55.36
Atrovent HFA	332.70
Combivent Respimat	426.45
Albuterol/ipratropium	426.45
Daily controller medication cost, USD		Red Book Online, 2020 (25)
LAMA	14.80
LABA	10.40
LABA + ICS	10.50
LABA + LAMA	17.14
LABA + LAMA + ICS	19.11
Remote monitoring*
Yearly frequency		Assumption
HCPCS Code 98975	1
HCPCS Code 98976	6
HCPCS Code 98980	6
Fees, USD		CMS 2022 Physician Fee Schedule [18]
HCPCS Code 98975	19.38
HCPCS Code 98976	55.72
HCPCS Code 98980	50.18
Reduction in HCRU with Propeller		Alshabani et al. [14] (base case)
ED visits	55%
Hospitalizations	30%
Reduction in SABA use with Propeller	59.4%	Chen et al. [13]

*For the purposes of this analysis, we conservatively assumed all patients in commercial plans were able to make a reimbursement claim to the respective payer
**HCPCS Code 98,975: Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment; HCPCS Code 98,976: Remote therapeutic monitoring (e.g. respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g. daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days; HCPCS 98980: Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 min
CMS: Center for Medicare and Medicaid Services; COPD: chronic obstructive pulmonary disease; ED: emergency department; GOLD: Global Initiative for Chronic Obstructive Lung Disease; HCPCS: Healthcare Common Procedural Coding System; HCRU: healthcare resource utilization; ICS: inhaled corticosteroid; LABA: long-acting beta-agonist; LAMA: long-acting muscarinic antagonist; PDC: proportion of days covered; SABA: short-acting beta-agonist; WAC: wholesale acquisition cost

ISSN: 1478-7547