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SUPPLEMENTARY MATERIALS

Impact of compliance with GOLD treatment recommendations on COPD health care resource utilization, cost, and exacerbations among COPD patients on maintenance therapy

Swetha R Palli, MS; Siting Zhou, PhD; Asif Shaikh, MD; and Vincent J Willey, PharmD

Supplementary Table 1 – Validated claims-based algorithm predictors for COPD cases to identify patients with COPD

Supplementary Table 2 – COPD maintenance medications and COPD/pneumonia diagnosis codes

Supplementary Table 3 – 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Treatment recommendations by GOLD A/B/C/D risk group for determining compliance to GOLD

Supplementary Table 4 – Covariate list include for all multivariate models at the start of backward selection process Supplementary Table 5a – Unadjusted all-cause and COPD-related healthcare encounters over follow-up for GOLD A/B and C/D risk groups

Supplementary Table 5b – Unadjusted all-cause and COPD-related costs over follow-up for GOLD A/B and C/D risk groups

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Supplementary Table 1 – Validated claims-based algorithm predictors for COPD cases to identify patients with COPD*

Predictors of COPD cases Predictors of non-COPD cases

Predictors Coefficient Predictors Coefficient Intercept 0.5095 Obstructive sleep apnea -0.5298 ≥3 claims diagnoses of COPD with 30 days 0.6484 Pulmonary fibrosis -0.4165 apart from each other Presence of Pulmonary rehabilitation 0.4960 Female -0.2943 Number of COPD inpatient hospitalizations 0.2021 Peptic ulcer/gastroesophageal reflux disease -0.2781 Presence of smoking codes in claims 0.1838 Allergic rhinitis -0.2554 Number of COPD ED visits 0.0915 Myocardial infarction -0.1748 Number of COPD office visits 0.0814 Hypertension -0.1473 Number of LAMA claims 0.0578 Antibiotic use -0.1414 Number of visits to pulmonologist 0.0394 Ischemic heart disease -0.0583 Presence of Respiratory failure 0.0319 Chronic sinusitis -0.0526 Number of SABA claims 0.0295 Pneumonia -0.0508 Number of ICS-LAMA claims 0.0268 Depression -0.0352 Number of LAMA-LABA claims 0.0239 Count of supplemental oxygen use 0.0089 *When COPD-confirmatory spirometry data is unavailable Model characteristics: Sensitivity: 0.672; Specificity: 0.670; Area under curve: 0.73; Predicted probability threshold: 0.75; Cross- validated Positive Predictive Value (95% CI): 0.860 (0.840 - 0.880) Reference: Palli S, Zhou S, Shaikh A, Willey V. Developing a claims’-based algorithm to identify US patients with COPD. Eur Respir J. Sep 2019, 54 (suppl 63) PA4431 COPD=chronic obstructive pulmonary disease; CI=confidence interval; ED=emergency department; ICS=inhaled corticosteroid; LABA=long-acting beta-2 agonist; LAMA=long-acting muscarinic antagonists; SABA=short-acting beta2-agonist

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Supplementary Table 2 – COPD maintenance medications and COPD/pneumonia diagnosis codes

Medication class GPI code starts with HCPCS Inhaled corticosteroids (ICS) All ICS 4440 Beclomethasone 44400010 J7622 44400015 J7626, J7627, J7633, J7634 44400017 Dexamethasone 44400020 44400030 J7641 44400033 44400036 44400040 J7683, J7684 Long acting beta-2 agonist

(LABA) Inhaled LABAs 44201058 44201027 J7606, J7640, Q4099 44201022 Indacaterol 44201042 44201012 J7605 HCI 44201052 Oral LABAs Vospire 44201010107410 44201010107420 Volmax 44201010107470 44201010107480 Proventil CR 44201010100410 Long-acting muscarinic

antagonists (LAMA) Aclidinium 44100007 Umeclidinium 44100090 Glycopyrrolate 44100020100107 44100080

Monohydrate Combinations LAMA-LABA Umeclidinium- 4420990295 Glycopyrrolate/formoterol 4420990254 Glycopyrrolate/indacaterol 4420990260 Tiotropium Bromide- 4420990292 Olodaterol HCl ICS-LABA Fluticasone-Salmeterol 4420990270 Mometasone-Formoterol 4420990290 Fluticasone-Vilanterol 4420990275 Formoterol-Budesonide 4420990241 Diagnosis ICD-9-CM ICD-10-CM J41.xx, J42.xx, J43.xx, COPD 491.xx, 492.xx, 496.xx J44.xx 011.62, 011.63, 011.64, 011.65, A0103, A0222, A3701, 011.66, 052.1, 055.1, 073.0, A3711, A3781, A3791, 115.05, 115.15, 115.95, 130.4, A481, A5484, B012, B052, Pneumonia 480.0, 480.1, 480.2, 480.3, 480.8, B0681, B250, B440, J09X1, 480.9, 481, 482.0, 482.1, 482.2, J1000, J1001, J1008, J1100, 482.30, 482.31, 482.32, 48H2.39, J1108, J120, J121, J122,

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482.40, 482.41, 482.42, 482.49, J123, J1281, J1289, J129, 482.81, 482.82, 482.83, 482.84, J13, J14, J150, J151, J1520, 482.89, 482.9, 483.0, 483.1, J15211, J15212, J1529, J153, 483.8, 484.1, 484.3, 484.6, 484.7, J154, J155, J156, J157, J158, 484.8, 485, 486, 487.0, 488.01, J159, J160, J168, J17, J180, 488.11, 488.81, 495.7, 495.8, J18, J182, J188, J189, J200, 495.9, 506.0, 507.0, 507.1, 507.8, J678, J679, J680, J690, J691, 516.30, 516.32, 516.33, 516.35, J698, J84111, J84113, 516.36, 516.37, 517.1, 997.31, J84114, J84116, J84117, 997.32 J842, J851, J954, J95851 COPD=chronic obstructive pulmonary disease; GPI=generic product identifier; HCPCS=Healthcare Common Procedure Coding System; ICD-x-CM=International Classification of Disease Clinical Modification; ICS=inhaled corticosteroid; LABA=long- acting beta-2 agonist LAMA=long-acting muscarinic antagonists

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Supplementary Table 3— 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Treatment recommendations by GOLD A/B/C/D risk group for determining compliance to GOLD

Patient Treatments in the Risk 12 months pre- Index treatments Group index period

A SABA, LABA, SAMA, or LAMA

If no prior COPD LABA or LAMA medications B If with prior use of LAMA+LABA combination therapy LABA or LAMA

If no prior COPD LAMA medications C LAMA+LABA combination therapy If with prior use of OR LAMA ICS +LABA combination therapy

If no prior COPD LABA+LAMA or LAMA medications

LAMA+LABA combination therapy If with prior use of D OR LAMA ICS+LABA combination therapy If with prior use of LAMA+LABA or LAMA+LABA+ICS combination therapy ICS+LABA COPD=chronic obstructive pulmonary disease; GOLD = Global Initiative for Chronic Obstructive Lung Disease; ICS=inhaled corticosteroid; LABA=long-acting beta2-agonist; LAMA=long-acting muscarinic antagonists; SABA=short-acting beta2-agonist; SAMA=short-acting muscarinic antagonists

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Supplementary Table 4 – Covariate list include for all multivariate models at the start of backward selection process

Covariates retained after backwards selection Outcome GOLD A/B GOLD C/D Female, Region of residence, Medicare advantage, index treating Medicare advantage, baseline chronic sinusitis, baseline congestive provider specialty, index year (2014-17), baseline anxiety, baseline heart failure, baseline osteoporosis, baseline renal disease, age, Time to first chronic sinusitis, baseline diabetes mellitus, baseline ischemic baseline COPD total costs, baseline COPD total medical costs, COPD heart disease, baseline Osteoporosis, baseline Pneumonia, age, baseline exacerbation counts, baseline severe exacerbation counts, exacerbation baseline Elixhauser comorbidity index score, baseline COPD total baseline moderate exacerbation episode costs costs, baseline COPD total medical costs, baseline exacerbation counts Female, Region of residence, Medicare advantage, index treating Medicare advantage, index treating provider specialty, baseline provider specialty, index year (2014-17), baseline anxiety, baseline anxiety, baseline diabetes mellitus, baseline dyspnea, baseline dyspnea, baseline congestive heart failure, baseline peripheral congestive heart failure, baseline peripheral vascular disease, baseline Time to first vascular disease, baseline obstructive sleep apnea, baseline osteoporosis, baseline obstructive sleep apnea, baseline pneumonia, severe COPD pneumonia, age, Baseline Elixhauser comorbidity index score, age, baseline COPD total costs, baseline COPD total medical costs, exacerbation baseline COPD total costs, baseline COPD total medical costs, baseline exacerbation counts, baseline severe exacerbation counts, baseline exacerbation counts, baseline exacerbation episode costs baseline exacerbation episode costs, baseline moderate exacerbation episode costs Region of residence, Medicare advantage, index treating provider Medicare advantage, index treating provider specialty, baseline specialty, baseline anxiety, baseline dyspnea, baseline congestive anxiety, baseline dyspnea, baseline congestive heart failure, baseline heart failure, baseline angina pectoris, baseline ischemic heart angina pectoris, baseline ischemic heart disease, baseline pneumonia, disease, baseline peripheral vascular disease, baseline renal age, baseline Elixhauser comorbidity index score, baseline disease, baseline pneumonia, age, baseline Elixhauser comorbidity exacerbation counts, baseline all-cause ED flag, baseline COPD index score, baseline exacerbation counts, baseline all-cause ED inpatient flag, baseline COPD ED flag, baseline all-cause ED counts, Number of use, baseline all-cause other outpatient visit use, baseline COPD baseline COPD inpatient counts, baseline COPD outpatient counts, COPD inpatient use, baseline COPD office visit use, baseline all-cause baseline all-cause total costs, baseline COPD inpatient costs inpatient inpatient counts, baseline all-cause outpatient counts, baseline admissions COPD inpatient counts, baseline COPD ED visit counts, baseline COPD office visit counts, baseline COPD outpatient counts, baseline all-cause total costs, baseline all-cause medical costs, baseline all-cause inpatient costs, baseline all-cause ED costs, baseline all-cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD ED costs

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Female, Medicare advantage, index treating provider specialty, baseline anxiety, baseline dyspnea, baseline ischemic heart disease, index year (2014-17), baseline anxiety, baseline ischemic heart baseline all-cause ED flag, baseline COPD inpatient flag, baseline disease, age, baseline Elixhauser comorbidity index score, baseline COPD ED flag, baseline all-cause ED counts, baseline COPD Number of exacerbation counts, baseline all-cause ED use, baseline all-cause inpatient counts, baseline COPD ED visit counts, baseline COPD COPD ED office visit use, baseline COPD inpatient use, baseline COPD ED outpatient counts, baseline all-cause total costs visits use, baseline all-cause ED counts, baseline COPD ED visit counts, baseline COPD office visit counts, baseline COPD outpatient counts, baseline all-cause total costs, baseline all-cause other outpatient visit costs Female, health plan type, index treating provider specialty, index Index treating provider specialty, baseline dyspnea, baseline year (2014-17), baseline anxiety, baseline diabetes mellitus, hypertension, baseline COPD total medical costs, baseline baseline dyspnea, baseline congestive heart failure, baseline exacerbation counts, baseline all-cause office visit flag, baseline all- myocardial infarction, baseline acute ischemic heart disease, cause other outpatient visit flag, baseline COPD inpatient flag, baseline peripheral vascular disease, baseline pneumonia, age, baseline COPD office visit flag, baseline all-cause inpatient counts, baseline Elixhauser comorbidity index score, baseline COPD total baseline all-cause ED counts, baseline all-cause office visit counts, costs, baseline COPD total medical costs, baseline exacerbation baseline all-cause outpatient counts, baseline COPD office visit Number of counts, baseline exacerbation episode costs, baseline all-cause counts, baseline all-cause medical costs, baseline all-cause inpatient COPD office office visit use, baseline all-cause other outpatient visit use, costs, baseline all-cause ED costs, baseline all-cause office visit costs, visits baseline COPD inpatient use, baseline COPD office visit use, baseline all-cause other outpatient visit costs, baseline COPD inpatient baseline COPD other outpatient use, baseline all-cause inpatient costs, baseline COPD outpatient counts counts, baseline all-cause ED counts, baseline all-cause office visit counts, baseline all-cause outpatient counts, baseline COPD office visit counts, baseline COPD outpatient counts, baseline all-cause total costs, baseline all-cause medical costs, baseline all-cause inpatient costs, baseline all-cause ED costs, baseline all-cause office visit costs, baseline all-cause other outpatient visit costs Female, health plan type, Medicare advantage, index treating Female, Medicare advantage, baseline dyspnea, baseline renal disease, provider specialty, index year (2014-17), baseline anxiety, baseline age, baseline Elixhauser comorbidity index score, baseline COPD total dyspnea, baseline congestive heart failure, baseline angina pectoris, costs, baseline COPD total medical costs, baseline exacerbation baseline renal disease, baseline obstructive sleep apnea, baseline counts, baseline exacerbation episode costs, baseline all-cause ED pneumonia, age, baseline Elixhauser comorbidity index score, flag, baseline COPD inpatient flag, baseline COPD ED flag, baseline Number of baseline COPD total medical costs, baseline exacerbation episode COPD office visit flag, baseline COPD other outpatient flag, baseline COPD other costs, baseline all-cause office visit use, baseline COPD inpatient COPD outpatient counts, baseline all-cause other outpatient visit costs, outpatient use, baseline COPD ED use, baseline COPD office visit use, baseline COPD office visit counts visits baseline COPD other outpatient use, baseline all-cause inpatient counts, baseline all-cause office visit counts, baseline all-cause outpatient counts, baseline COPD ED visit counts, baseline COPD office visit counts, baseline COPD outpatient counts, baseline all- cause medical costs, baseline all-cause inpatient costs, baseline all- Page 7 of 21

cause ED costs, baseline all-cause office visit costs, baseline all- cause other outpatient visit costs, baseline COPD inpatient costs, baseline COPD ED costs, baseline COPD office visit counts, baseline COPD outpatient counts Female, region of residence, Medicare advantage, index treating Female, Medicare advantage, baseline chronic sinusitis, baseline provider specialty, index year (2014-17), baseline chronic sinusitis, dyspnea, baseline congestive heart failure, baseline myocardial baseline diabetes mellitus, baseline dyspnea, baseline congestive infarction, baseline angina pectoris, baseline ischemic heart disease, heart failure, baseline myocardial infarction, baseline acute baseline renal disease, baseline ischemic stroke, baseline pneumonia, ischemic heart disease, baseline angina pectoris, baseline baseline Elixhauser comorbidity index score, baseline COPD total peripheral vascular disease, baseline renal disease, baseline costs, baseline COPD total medical costs, pre-index all-cause inpatient pneumonia, age, baseline Elixhauser comorbidity index score, flag, baseline all-cause ED flag, baseline all-cause office visit flag, baseline COPD total costs, baseline COPD total medical costs, baseline all-cause other outpatient visit flag, baseline COPD ED flag, Total COPD baseline exacerbation episode costs, baseline all-cause other baseline all-cause office visit counts, baseline COPD inpatient counts, costs outpatient visit use, baseline COPD inpatient use, baseline COPD baseline COPD outpatient counts, baseline all-cause medical costs, office visit use, baseline all-cause inpatient counts, baseline all- baseline all-cause inpatient costs, baseline all-cause ED costs, baseline cause ED counts, baseline COPD ED visit counts, baseline COPD all-cause office visit costs, baseline all-cause other outpatient visit office visit counts, baseline COPD outpatient counts, baseline all- costs, baseline COPD inpatient costs, baseline COPD ED costs cause total costs, baseline all-cause medical costs, baseline all- cause inpatient costs, baseline all-cause ED costs, baseline all- cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD inpatient costs, baseline COPD ED costs Female, region of residence, Medicare advantage, index treating Female, Medicare advantage, index year (2014-17), baseline chronic provider specialty, baseline chronic sinusitis, baseline diabetes sinusitis, baseline dyspnea, baseline congestive heart failure, baseline mellitus, baseline dyspnea, baseline congestive heart failure, myocardial infarction, baseline pneumonia, baseline Elixhauser baseline myocardial infarction, baseline acute ischemic heart comorbidity index score, baseline COPD total medical costs, pre- disease, baseline peripheral vascular disease, baseline renal index all-cause inpatient flag, baseline all-cause ED flag, baseline all- disease, baseline pneumonia, age, baseline Elixhauser comorbidity cause office visit flag, baseline COPD ED flag, baseline all-cause index score, baseline COPD total costs, baseline COPD total office visit counts, baseline COPD inpatient counts, baseline COPD COPD medical costs, baseline all-cause ED use, baseline COPD inpatient outpatient counts, baseline all-cause medical costs, baseline all-cause Medical costs use, baseline COPD office visit use, baseline all-cause inpatient inpatient costs, baseline all-cause ED costs, baseline all-cause office counts, baseline all-cause ED counts, baseline COPD ED visit visit costs, baseline all-cause other outpatient visit costs, baseline counts, baseline COPD office visit counts, baseline COPD COPD inpatient costs, baseline COPD ED costs outpatient counts, baseline all-cause total costs, baseline all-cause medical costs, baseline all-cause inpatient costs, baseline all-cause ED costs, baseline all-cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD inpatient costs, baseline COPD ED costs

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Female, region of residence, Medicare advantage, index treating Index year (2014-17), baseline chronic sinusitis, baseline dyspnea, provider specialty, baseline chronic sinusitis, baseline diabetes baseline congestive heart failure, baseline pneumonia, baseline mellitus, baseline dyspnea, baseline congestive heart failure, Elixhauser comorbidity index score, baseline COPD total medical baseline myocardial infarction, baseline acute ischemic heart costs, pre-index all-cause inpatient flag, baseline all-cause ED flag, disease, baseline peripheral vascular disease, baseline renal baseline all-cause office visit flag, baseline all-cause office visit disease, baseline pneumonia, age, baseline Elixhauser comorbidity counts, baseline all-cause medical costs, baseline all-cause inpatient Inpatient index score, baseline COPD inpatient use, baseline COPD office costs, baseline all-cause ED costs, baseline all-cause other outpatient costs visit use, baseline all-cause inpatient counts, baseline all-cause ED visit costs, baseline COPD inpatient costs counts, baseline COPD ED visit counts, baseline COPD outpatient counts, baseline all-cause total costs, baseline all-cause medical costs, baseline all-cause inpatient costs, baseline all-cause ED costs, baseline all-cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD ED costs Region of residence, Medicare advantage, index treating provider Female, region of residence, Medicare advantage, baseline chronic specialty, index year (2014-17), baseline anxiety, baseline sinusitis, baseline dyspnea, baseline congestive heart failure, baseline congestive heart failure, baseline hypertension, baseline acute hypertension, baseline ischemic heart disease, baseline exacerbation ischemic heart disease, baseline ischemic heart disease, baseline episode costs, baseline all-cause ED flag, baseline all-cause other peripheral vascular disease, baseline COPD total costs, baseline outpatient visit flag, baseline COPD inpatient flag, baseline all-cause COPD total medical costs, baseline exacerbation counts, baseline inpatient counts, baseline COPD ED visit counts, baseline all-cause all-cause inpatient use, baseline all-cause ED use, baseline all- total costs, baseline all-cause ED costs, baseline COPD outpatient ER costs cause office visit use, baseline COPD ED use, baseline COPD counts office visit use, baseline all-cause ED counts, baseline COPD inpatient counts, baseline COPD office visit counts, baseline COPD outpatient counts, baseline all-cause total costs, baseline all- cause inpatient costs, baseline all-cause ED costs, baseline all- cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD outpatient counts Female, region of residence, Medicare advantage, index treating Medicare advantage, index treating provider specialty, baseline provider specialty, index year (2014-17), baseline diabetes diabetes mellitus, baseline dyspnea, baseline congestive heart failure, mellitus, baseline dyspnea, baseline hypertension, baseline age, baseline COPD total medical costs, baseline exacerbation counts, pneumonia, age, baseline Elixhauser comorbidity index score, baseline all-cause office visit flag, baseline all-cause other outpatient baseline COPD total costs, baseline COPD total medical costs, visit flag, baseline COPD inpatient flag, baseline COPD other Office visit baseline exacerbation counts, baseline exacerbation episode costs, outpatient flag, baseline all-cause inpatient counts, baseline all-cause costs baseline all-cause office visit use, baseline all-cause other ED counts, baseline COPD ED visit counts, baseline COPD office outpatient visit use, baseline COPD inpatient use, baseline all- visit counts, baseline COPD outpatient counts, baseline all-cause cause inpatient counts, baseline all-cause ED counts, baseline all- medical costs, baseline all-cause inpatient costs, baseline all-cause cause office visit counts, baseline all-cause outpatient counts, office visit costs, baseline all-cause other outpatient visit costs, baseline COPD office visit counts, baseline COPD outpatient baseline COPD inpatient costs, baseline COPD office visit counts counts, baseline all-cause total costs, baseline all-cause medical Page 9 of 21

costs, baseline all-cause inpatient costs, baseline all-cause ED costs, baseline all-cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD office visit counts Female, health plan type, Medicare advantage, index treating Medicare advantage, baseline diabetes mellitus, baseline dyspnea, provider specialty, baseline diabetes mellitus, baseline dyspnea, baseline congestive heart failure, baseline pneumonia, baseline baseline congestive heart failure, baseline hypertension, baseline Elixhauser comorbidity index score, baseline COPD total costs, renal disease, baseline obstructive sleep apnea, baseline baseline COPD total medical costs, baseline all-cause ED flag, pneumonia, age, baseline Elixhauser comorbidity index score, baseline all-cause office visit flag, baseline COPD inpatient flag, baseline COPD total costs, baseline COPD total medical costs, baseline COPD other outpatient flag, baseline all-cause inpatient Other baseline exacerbation episode costs, baseline all-cause inpatient counts, baseline all-cause ED counts, baseline COPD ED visit counts, Outpatient use, baseline all-cause ED use, baseline COPD inpatient use, baseline COPD outpatient counts, baseline all-cause medical costs, costs baseline COPD office visit use, baseline COPD other outpatient baseline all-cause ED costs, baseline all-cause other outpatient visit use, baseline all-cause ED counts, baseline COPD office visit costs, baseline COPD ED costs, baseline COPD outpatient counts counts, baseline COPD outpatient counts, baseline all-cause medical costs, baseline all-cause inpatient costs, baseline all-cause ED costs, baseline all-cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD inpatient costs, baseline COPD office visit counts Region of residence, index treating provider specialty, index year Index treating provider specialty, index year (2014-17), baseline (2014-17), baseline diabetes mellitus, baseline dyspnea, baseline anxiety, baseline diabetes mellitus, baseline dyspnea, baseline ischemic heart disease, baseline pneumonia, age, baseline COPD congestive heart failure, baseline renal disease, baseline COPD total total costs, baseline COPD total medical costs, baseline costs, baseline COPD total medical costs, baseline all-cause ED flag, COPD exacerbation counts, baseline exacerbation episode costs, baseline baseline all-cause other outpatient visit flag, baseline all-cause office Pharmacy all-cause ED use, baseline all-cause office visit use, baseline all- visit counts, baseline COPD outpatient counts, baseline all-cause total costs cause ED counts, baseline all-cause office visit counts, baseline costs, baseline all-cause medical costs, baseline all-cause inpatient COPD office visit counts, baseline COPD outpatient counts, costs, baseline all-cause office visit costs, baseline all-cause other baseline all-cause total costs, baseline all-cause medical costs, outpatient visit costs, baseline COPD outpatient counts baseline all-cause inpatient costs, baseline all-cause other outpatient visit costs GOLD A GOLD B GOLD C GOLD D Female, region of residence, Female, region of residence, Female, index treating provider Medicare advantage, baseline health plan type, Medicare Medicare advantage, index year specialty, baseline congestive chronic sinusitis, baseline advantage, index treating (2014-17), baseline diabetes heart failure, baseline hypertension, age, baseline Time to first provider specialty, index year mellitus, baseline dyspnea, exacerbation counts, baseline Elixhauser comorbidity index COPD (2014-17), baseline anxiety, baseline hypertension, baseline severe exacerbation counts, score, baseline COPD total costs, exacerbation baseline chronic sinusitis, ischemic heart disease, baseline baseline moderate exacerbation baseline COPD total medical baseline myocardial infarction, renal disease, baseline episode costs costs, baseline exacerbation baseline osteoporosis, baseline pneumonia, age, baseline COPD Page 10 of 21

pneumonia, age, baseline total costs, baseline COPD total counts, baseline moderate Elixhauser comorbidity index medical costs, baseline exacerbation episode costs score, baseline exacerbation exacerbation counts counts Region of residence, Medicare Region of residence, Medicare Female, baseline ischemic heart Medicare advantage, index advantage, index treating advantage, index treating disease, age, baseline Elixhauser treating provider specialty, provider specialty, index year provider specialty, baseline comorbidity index score, baseline baseline dyspnea, baseline (2014-17), baseline dyspnea, congestive heart failure, baseline COPD total medical costs, congestive heart failure, baseline baseline congestive heart myocardial infarction, baseline baseline exacerbation counts, pneumonia, age, baseline failure, baseline peripheral angina pectoris, baseline baseline COPD inpatient flag, Elixhauser comorbidity index vascular disease, baseline renal ischemic heart disease, baseline baseline all-cause inpatient score, baseline COPD total costs, disease, age, baseline pneumonia, age, baseline counts, baseline COPD inpatient baseline COPD total medical Elixhauser comorbidity index Elixhauser comorbidity index costs costs, baseline exacerbation score, baseline all-cause score, baseline exacerbation counts, baseline COPD inpatient Number of inpatient use, baseline all-cause counts, baseline all-cause ED flag, baseline all-cause ED COPD ED use, baseline all-cause flag, baseline COPD inpatient counts, baseline all-cause office inpatient other outpatient visit use, flag, baseline COPD office visit visit counts, baseline COPD admissions baseline COPD office visit use, flag, baseline all-cause inpatient inpatient counts, baseline COPD baseline COPD inpatient counts, baseline all-cause outpatient counts, baseline all- counts, baseline COPD ED outpatient counts, baseline cause inpatient costs, baseline all- visit counts, baseline COPD COPD inpatient counts, baseline cause ED costs, baseline COPD office visit counts, baseline COPD ED visit counts, baseline outpatient counts COPD outpatient counts, COPD office visit counts, baseline all-cause office visit baseline COPD outpatient costs counts, baseline all-cause total costs, baseline all-cause medical costs, baseline all-cause ED costs, baseline COPD ED costs Female, index treating provider Region of residence, Medicare Baseline chronic sinusitis, Region of residence, Medicare specialty, index year (2014-17), advantage, index treating baseline obstructive sleep apnea, advantage, baseline anxiety, baseline anxiety, baseline provider specialty, index year baseline all-cause ED flag, baseline dyspnea, baseline myocardial infarction, age, (2014-17), baseline anxiety, baseline COPD inpatient flag, ischemic heart disease, baseline Number of baseline Elixhauser baseline ischemic heart disease, baseline COPD ED flag, baseline osteoporosis, baseline COPD ED comorbidity index score, age, baseline exacerbation all-cause ED counts, baseline exacerbation episode costs, visits baseline exacerbation episode counts, pre-index all-cause COPD inpatient counts baseline COPD ED flag, baseline costs, baseline all-cause ED inpatient flag, baseline all-cause all-cause inpatient counts, use, baseline all-cause office ED flag, baseline COPD baseline all-cause ED counts, visit use, baseline COPD inpatient flag, baseline COPD baseline COPD ED visit counts, inpatient use, baseline COPD ED flag, baseline COPD other baseline all-cause inpatient costs Page 11 of 21

ED use, baseline all-cause outpatient flag, baseline all- inpatient counts, baseline all- cause ED counts, baseline cause ED counts, baseline COPD ED visit counts, baseline COPD ED visit counts, COPD office visit counts, baseline COPD outpatient baseline COPD outpatient counts counts, baseline all-cause medical costs, baseline all-cause other outpatient visit costs, baseline COPD inpatient costs Female, index treating provider Female, index treating provider Index treating provider specialty, Index treating provider specialty, specialty, index year (2014-17), specialty, index year (2014-17), baseline acute ischemic heart baseline dyspnea, baseline COPD baseline anxiety, baseline baseline chronic sinusitis, disease, baseline peripheral total medical costs, baseline diabetes mellitus, baseline baseline diabetes mellitus, vascular disease, baseline renal exacerbation counts, baseline all- dyspnea, baseline congestive baseline dyspnea, baseline disease, age, baseline COPD total cause office visit flag, baseline heart failure, baseline acute myocardial infarction, baseline costs, baseline COPD total all-cause other outpatient visit ischemic heart disease, baseline pneumonia, baseline COPD total medical costs, baseline severe flag, baseline COPD inpatient peripheral vascular disease, costs, baseline COPD total exacerbation counts, baseline flag, baseline COPD office visit baseline pneumonia, age, medical costs, baseline moderate exacerbation episode flag, baseline all-cause inpatient baseline COPD total costs, exacerbation counts, baseline costs, baseline all-cause ED flag, counts, baseline all-cause office baseline COPD total medical all-cause office visit flag, baseline all-cause office visit visit counts, baseline all-cause costs, baseline exacerbation baseline all-cause other flag, baseline all-cause other outpatient counts, baseline COPD counts, baseline exacerbation outpatient visit flag, baseline outpatient visit flag, baseline all- office visit counts, baseline all- episode costs, baseline all- COPD inpatient flag, baseline cause inpatient counts, baseline cause medical costs, baseline all- Number of cause office visit use, baseline COPD office visit flag, baseline all-cause office visit counts, cause inpatient costs, baseline all- COPD office all-cause other outpatient visit COPD other outpatient flag, baseline all-cause outpatient cause ED costs, baseline all-cause visits use, baseline COPD office visit baseline all-cause inpatient counts, baseline COPD office office visit costs, baseline all- use, baseline COPD other counts, baseline all-cause ED visit counts, baseline all-cause cause other outpatient visit costs, outpatient use, baseline all- counts, baseline all-cause office medical costs, baseline all-cause baseline COPD inpatient costs, cause inpatient counts, baseline visit counts, baseline all-cause inpatient costs, baseline all-cause baseline COPD outpatient counts all-cause office visit counts, outpatient counts, baseline ED costs, baseline all-cause baseline all-cause outpatient COPD office visit counts, office visit costs, baseline all- counts, baseline COPD baseline COPD outpatient cause other outpatient visit costs inpatient counts, baseline counts, baseline all-cause total COPD office visit counts, costs, baseline all-cause medical baseline all-cause total costs, costs, baseline all-cause baseline all-cause medical inpatient costs, baseline all- costs, baseline all-cause cause ED costs, baseline all- inpatient costs, baseline all- cause office visit costs, baseline cause ED costs, baseline all- Page 12 of 21

cause office visit costs, all-cause other outpatient visit baseline all-cause other costs outpatient visit costs, baseline COPD inpatient costs, baseline COPD outpatient counts Female, Medicare advantage, Female, region of residence, Medicare advantage, index Female, health plan type, index year (2014-17), baseline Medicare advantage, index treating provider specialty, age, Medicare advantage, baseline anxiety, baseline dyspnea, treating provider specialty, index baseline Elixhauser comorbidity dyspnea, baseline renal disease, baseline obstructive sleep year (2014-17), baseline anxiety, index score, baseline age, baseline Elixhauser apnea, baseline pneumonia, baseline chronic sinusitis, exacerbation episode costs, comorbidity index score, baseline age, baseline Elixhauser baseline dyspnea, baseline baseline severe exacerbation exacerbation counts, baseline comorbidity index score, congestive heart failure, baseline episode costs, baseline all-cause COPD inpatient flag, baseline baseline COPD total medical obstructive sleep apnea, baseline ED flag, baseline COPD inpatient COPD other outpatient flag, costs, baseline exacerbation pneumonia, age, baseline flag, baseline COPD office visit baseline all-cause office visit episode costs, baseline all- Elixhauser comorbidity index flag, baseline COPD other counts, baseline COPD outpatient cause ED use, baseline all- score, baseline COPD total outpatient flag, baseline all-cause counts, baseline all-cause total cause office visit use, baseline medical costs, baseline outpatient counts, baseline COPD costs, baseline all-cause inpatient Number of COPD inpatient use, baseline exacerbation episode costs, office visit counts, baseline costs, baseline all-cause other COPD other COPD office visit use, baseline baseline all-cause other COPD outpatient counts, baseline outpatient visit costs, baseline outpatient COPD other outpatient use, outpatient visit flag, baseline all-cause medical costs, baseline COPD inpatient costs, baseline visits baseline all-cause inpatient COPD inpatient flag, baseline all-cause other outpatient visit COPD office visit counts counts, baseline all-cause office COPD office visit flag, baseline costs visit counts, baseline COPD COPD other outpatient flag, outpatient counts, baseline all- baseline all-cause office visit cause medical costs, baseline counts, baseline all-cause all-cause inpatient costs, outpatient counts, baseline baseline all-cause other COPD office visit counts, outpatient visit costs, baseline baseline COPD outpatient COPD inpatient costs, baseline counts, baseline COPD ED COPD office visit counts, costs, baseline COPD office baseline COPD outpatient visit counts counts

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Female, region of residence, Female, health plan type, Female, Medicare advantage, Medicare advantage, baseline Medicare advantage, index Medicare advantage, index index treating provider specialty, chronic sinusitis, baseline treating provider specialty, treating provider specialty, index year (2014-17), baseline dyspnea, baseline congestive index year (2014-17), baseline baseline chronic sinusitis, chronic sinusitis, baseline heart failure, baseline myocardial chronic sinusitis, baseline baseline congestive heart failure, myocardial infarction, baseline infarction, baseline angina diabetes mellitus, baseline baseline myocardial infarction, acute ischemic heart disease, pectoris, baseline renal disease, dyspnea, baseline congestive baseline acute ischemic heart baseline ischemic heart disease, baseline pneumonia, baseline heart failure, baseline angina disease, baseline peripheral baseline peripheral vascular Elixhauser comorbidity index pectoris, baseline peripheral vascular disease, baseline renal disease, baseline osteoporosis, score, baseline COPD total costs, vascular disease, age, baseline disease, baseline pneumonia, baseline obstructive sleep apnea, baseline COPD total medical Elixhauser comorbidity index baseline Elixhauser comorbidity baseline ischemic stroke, baseline costs, baseline moderate score, baseline COPD total index score, baseline COPD COPD total costs, baseline exacerbation episode costs, costs, baseline COPD total total costs, baseline COPD total exacerbation counts, baseline baseline all-cause ED flag, medical costs, baseline medical costs, pre-index all- exacerbation episode costs, baseline all-cause other outpatient exacerbation counts, baseline cause inpatient flag, baseline baseline severe exacerbation visit flag, baseline COPD Total COPD all-cause inpatient use, baseline COPD inpatient flag, baseline episode costs, pre-index all-cause inpatient flag, baseline COPD costs all-cause ED use, baseline all- COPD ED flag, baseline all- inpatient flag, baseline all-cause other outpatient flag, baseline all- cause other outpatient visit use, cause inpatient counts, baseline office visit flag, baseline all- cause ED counts, baseline all- baseline COPD ED use, all-cause ED counts, baseline cause office visit counts, baseline cause outpatient counts, baseline baseline COPD office visit use, COPD outpatient counts, all-cause outpatient counts, COPD inpatient counts, baseline baseline all-cause ED counts, baseline all-cause total costs, baseline COPD outpatient counts, COPD ED visit counts, baseline baseline COPD ED visit baseline all-cause medical costs, baseline COPD inpatient costs all-cause total costs, baseline all- counts, baseline COPD baseline all-cause ED costs, cause medical costs, baseline all- outpatient counts, baseline all- baseline all-cause other cause inpatient costs, baseline all- cause total costs, baseline all- outpatient visit costs, baseline cause ED costs, baseline COPD cause inpatient costs, baseline COPD inpatient costs, baseline ED costs, baseline COPD all-cause ED costs, baseline all- COPD ED costs outpatient counts cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD office visit counts Female, region of residence, Female, health plan type, Female, Medicare advantage, Medicare advantage, baseline Medicare advantage, index Medicare advantage, index index year (2014-17), baseline chronic sinusitis, baseline treating provider specialty, treating provider specialty, chronic sinusitis, baseline dyspnea, baseline congestive COPD baseline chronic sinusitis, baseline congestive heart failure, myocardial infarction, baseline heart failure, baseline angina Medical costs baseline diabetes mellitus, baseline myocardial infarction, acute ischemic heart disease, pectoris, baseline renal disease, baseline dyspnea, baseline baseline acute ischemic heart baseline peripheral vascular baseline pneumonia, baseline congestive heart failure, disease, baseline peripheral disease, baseline osteoporosis, Elixhauser comorbidity index baseline peripheral vascular vascular disease, baseline baseline obstructive sleep apnea, score, baseline all-cause ED flag, Page 14 of 21

disease, age, baseline pneumonia, age, baseline baseline Elixhauser comorbidity baseline COPD inpatient flag, Elixhauser comorbidity index Elixhauser comorbidity index index score, baseline COPD total baseline COPD inpatient counts, score, baseline COPD total score, baseline COPD total medical costs, baseline baseline COPD outpatient counts, costs, baseline COPD total medical costs, pre-index all- exacerbation counts, baseline baseline all-cause total costs, medical costs, baseline cause inpatient flag, baseline all- exacerbation episode costs, baseline all-cause medical costs, exacerbation counts, baseline cause ED flag, baseline COPD baseline severe exacerbation baseline all-cause inpatient costs, all-cause inpatient use, baseline inpatient flag, baseline all-cause episode costs, pre-index all-cause baseline all-cause ED costs, all-cause ED use, baseline inpatient counts, baseline all- inpatient flag, baseline all-cause baseline all-cause office visit COPD ED use, baseline COPD cause ED counts, baseline office visit flag, baseline all- costs, baseline all-cause other office visit use, baseline all- COPD ED visit counts, baseline cause office visit counts, baseline outpatient visit costs, baseline cause ED counts, baseline COPD outpatient counts, all-cause outpatient counts, COPD inpatient costs, baseline COPD ED visit counts, baseline all-cause total costs, baseline COPD outpatient counts, COPD outpatient counts baseline COPD outpatient baseline all-cause medical costs, baseline all-cause other outpatient counts, baseline all-cause total baseline all-cause ED costs, visit costs costs, baseline all-cause baseline all-cause other inpatient costs, baseline all- outpatient visit costs, baseline cause ED costs, baseline all- COPD inpatient costs, baseline cause office visit costs, COPD ED costs baseline all-cause other outpatient visit costs, baseline COPD office visit counts Region of residence, Medicare Baseline congestive heart Female, region of residence, Baseline chronic sinusitis, advantage, index treating failure, baseline myocardial baseline chronic sinusitis, baseline dyspnea, baseline angina provider specialty, baseline infarction, baseline acute baseline acute ischemic heart pectoris, baseline pneumonia, chronic sinusitis, baseline ischemic heart disease, baseline disease, baseline peripheral baseline Elixhauser comorbidity diabetes mellitus, baseline peripheral vascular disease, vascular disease, baseline index score, baseline COPD total dyspnea, baseline congestive baseline pneumonia, baseline obstructive sleep apnea, baseline medical costs, baseline all-cause heart failure, baseline Elixhauser comorbidity index COPD total medical costs, pre- ED flag, baseline COPD inpatient peripheral vascular disease, score, baseline COPD inpatient index all-cause inpatient flag, flag, baseline all-cause outpatient Inpatient age, baseline Elixhauser flag, baseline all-cause inpatient baseline all-cause office visit counts, baseline all-cause total costs comorbidity index score, counts, baseline all-cause ED flag, baseline all-cause office costs, baseline all-cause medical baseline COPD total costs, counts, baseline COPD visit counts, baseline all-cause costs, baseline all-cause inpatient baseline COPD total medical outpatient counts, baseline all- outpatient counts, baseline COPD costs, baseline all-cause ED costs, baseline all-cause cause total costs, baseline all- outpatient counts costs, baseline all-cause office inpatient use, baseline COPD cause medical costs, baseline visit costs, baseline all-cause ED use, baseline COPD office all-cause ED costs, baseline all- other outpatient visit costs, visit use, baseline COPD ED cause other outpatient visit costs baseline COPD inpatient costs visit counts, baseline COPD outpatient counts, baseline all- Page 15 of 21

cause office visit costs, baseline all-cause other outpatient visit costs, baseline COPD outpatient counts Female, region of residence, Region of residence, Medicare Female, Medicare advantage, Region of residence, Medicare health plan type, Medicare advantage, index treating index treating provider specialty, advantage, baseline anxiety, advantage, index year (2014- provider specialty, index year baseline congestive heart failure, baseline chronic sinusitis, 17), baseline anxiety, baseline (2014-17), baseline anxiety, baseline renal disease, baseline baseline hypertension, baseline myocardial infarction, baseline baseline chronic sinusitis, Elixhauser comorbidity index ischemic heart disease, baseline hypertension, baseline acute baseline ischemic heart disease, score, baseline moderate COPD total costs, baseline COPD ischemic heart disease, baseline baseline peripheral vascular exacerbation episode costs, pre- total medical costs, baseline osteoporosis, baseline disease, baseline osteoporosis, index all-cause inpatient flag, exacerbation episode costs, obstructive sleep apnea, baseline COPD total costs, baseline all-cause ED flag, baseline severe exacerbation baseline COPD total medical baseline COPD total medical baseline all-cause other outpatient episode costs, pre-index all-cause costs, baseline exacerbation costs, baseline exacerbation visit flag, baseline COPD inpatient flag, baseline all-cause counts, baseline exacerbation counts, pre-index all-cause inpatient flag, baseline all-cause other outpatient visit flag, episode costs, baseline all- inpatient flag, baseline all-cause inpatient counts, baseline all- baseline COPD ED flag, baseline ER costs cause inpatient use, baseline ED flag, baseline COPD ED cause ED counts, baseline all- COPD office visit flag, baseline all-cause ED use, baseline all- flag, baseline COPD other cause office visit counts, baseline COPD inpatient counts, baseline cause office visit use, baseline outpatient flag, baseline all- all-cause outpatient counts COPD ED visit counts, baseline COPD inpatient use, baseline cause ED counts, baseline all- all-cause total costs, baseline all- COPD office visit use, baseline cause office visit counts, cause inpatient costs, baseline all- all-cause ED counts, baseline baseline all-cause outpatient cause ED costs, baseline all-cause COPD ED visit counts, counts, baseline COPD inpatient other outpatient visit costs, baseline COPD office visit counts, baseline COPD baseline COPD outpatient counts counts, baseline all-cause total outpatient counts, baseline all- costs, baseline all-cause cause total costs, baseline all- medical costs, baseline all- cause inpatient costs, baseline cause ED costs, baseline COPD all-cause ED costs, baseline all- outpatient counts cause other outpatient visit costs Female, region of residence, Female, region of residence, Medicare advantage, index Medicare advantage, index Medicare advantage, index Medicare advantage, index treating provider specialty, pre- treating provider specialty, treating provider specialty, treating provider specialty, index index all-cause inpatient flag, baseline congestive heart failure, index year (2014-17), baseline year (2014-17), baseline chronic baseline all-cause ED flag, age, baseline COPD total medical Office visit diabetes mellitus, baseline sinusitis, baseline diabetes baseline COPD office visit flag, costs, baseline exacerbation costs dyspnea, baseline hypertension, mellitus, baseline dyspnea, baseline all-cause inpatient counts, baseline all-cause office baseline angina pectoris, baseline hypertension, baseline counts, baseline all-cause visit flag, baseline all-cause other baseline obstructive sleep pneumonia, age, baseline outpatient counts, baseline COPD outpatient visit flag, baseline apnea, baseline pneumonia, Elixhauser comorbidity index ED visit counts, baseline all- COPD inpatient flag, baseline Page 16 of 21

age, baseline Elixhauser score, baseline COPD total cause total costs, baseline all- COPD office visit flag, baseline comorbidity index score, costs, baseline exacerbation cause inpatient costs, baseline all- COPD other outpatient flag, baseline COPD total costs, counts, baseline all-cause office cause other outpatient visit costs, baseline all-cause inpatient baseline COPD total medical visit flag, baseline all-cause baseline COPD office visit counts counts, baseline all-cause ED costs, baseline exacerbation other outpatient visit flag, counts, baseline COPD ED visit episode costs, baseline all- baseline COPD inpatient flag, counts, baseline COPD office cause inpatient use, baseline baseline all-cause inpatient visit counts, baseline COPD all-cause office visit use, counts, baseline all-cause ED outpatient counts, baseline all- baseline all-cause other counts, baseline all-cause office cause medical costs, baseline all- outpatient visit use, baseline visit counts, baseline all-cause cause inpatient costs, baseline all- all-cause inpatient counts, outpatient counts, baseline cause ED costs, baseline all-cause baseline all-cause office visit COPD office visit counts, office visit costs, baseline all- counts, baseline all-cause baseline COPD outpatient cause other outpatient visit costs, outpatient counts, baseline counts, baseline all-cause total baseline COPD inpatient costs, COPD office visit counts, costs, baseline all-cause medical baseline COPD office visit counts baseline all-cause medical costs, baseline all-cause costs, baseline all-cause inpatient costs, baseline all- inpatient costs, baseline all- cause ED costs, baseline all- cause office visit costs, cause office visit costs, baseline baseline all-cause other all-cause other outpatient visit outpatient visit costs, baseline costs, baseline COPD inpatient COPD office visit counts costs, baseline COPD office visit counts, baseline COPD outpatient counts Female, Medicare advantage, Female, health plan type, Female, Medicare advantage, Medicare advantage, index index treating provider Medicare advantage, index index year (2014-17), baseline treating provider specialty, specialty, index year (2014-17), treating provider specialty, Elixhauser comorbidity index baseline diabetes mellitus, baseline diabetes mellitus, baseline dyspnea, baseline score, baseline all-cause office baseline congestive heart failure, baseline dyspnea, baseline congestive heart failure, baseline visit flag, baseline COPD baseline ischemic heart disease, hypertension, baseline acute hypertension, baseline acute inpatient flag, baseline COPD ED baseline pneumonia, baseline Other ischemic heart disease, baseline ischemic heart disease, baseline flag, baseline COPD other COPD total costs, baseline COPD Outpatient angina pectoris, baseline ischemic heart disease, baseline outpatient flag, baseline all-cause total medical costs, pre-index all- costs pneumonia, age, baseline renal disease, baseline inpatient counts, baseline COPD cause inpatient flag, baseline all- Elixhauser comorbidity index obstructive sleep apnea, baseline outpatient counts, baseline all- cause ED flag, baseline COPD score, baseline COPD total pneumonia, baseline Elixhauser cause office visit costs, baseline ED flag, baseline COPD office costs, baseline COPD total comorbidity index score, all-cause other outpatient visit visit flag, baseline COPD other medical costs, baseline baseline COPD total costs, costs, baseline COPD ED costs, outpatient flag, baseline all-cause exacerbation episode costs, baseline COPD total medical baseline COPD outpatient counts ED counts, baseline COPD ED baseline all-cause inpatient use, costs, pre-index all-cause visit counts, baseline COPD Page 17 of 21

baseline all-cause ED use, inpatient flag, baseline all-cause outpatient counts, baseline all- baseline COPD office visit use, ED flag, baseline COPD cause ED costs, baseline COPD baseline COPD other outpatient inpatient flag, baseline COPD ED costs, baseline COPD use, baseline all-cause ED office visit flag, baseline COPD outpatient counts counts, baseline COPD other outpatient flag, baseline outpatient counts, baseline all- all-cause ED counts, baseline cause medical costs, baseline all-cause office visit counts, all-cause inpatient costs, baseline all-cause outpatient baseline all-cause ED costs, counts, baseline COPD office baseline all-cause office visit visit counts, baseline COPD costs, baseline all-cause other outpatient counts, baseline all- outpatient visit costs, baseline cause ED costs, baseline all- COPD ED costs, baseline cause other outpatient visit COPD outpatient counts costs, baseline COPD inpatient costs, baseline COPD office visit counts Index treating provider Region of residence, index Index treating provider specialty, Index treating provider specialty, specialty, index year (2014-17), treating provider specialty, index index year (2014-17), baseline index year (2014-17), baseline baseline diabetes mellitus, year (2014-17), baseline anxiety, dyspnea, baseline acute ischemic anxiety, baseline diabetes baseline dyspnea, baseline baseline diabetes mellitus, heart disease, baseline Elixhauser mellitus, baseline renal disease, angina pectoris, baseline baseline dyspnea, baseline comorbidity index score, baseline age, baseline COPD total costs, peripheral vascular disease, ischemic heart disease, age, COPD total costs, baseline COPD baseline COPD total medical baseline pneumonia, age, baseline COPD total costs, total medical costs, baseline costs, baseline all-cause ED flag, baseline COPD total costs, baseline COPD total medical COPD other outpatient flag, baseline all-cause other outpatient baseline COPD total medical costs, baseline exacerbation baseline all-cause office visit visit flag, baseline COPD COPD costs, baseline exacerbation counts, baseline all-cause office counts outpatient counts, baseline all- Pharmacy episode costs, baseline all- visit flag, baseline all-cause ED cause total costs, baseline all- costs cause office visit use, baseline counts, baseline all-cause office cause medical costs, baseline all- all-cause ED counts, baseline visit counts, baseline COPD cause inpatient costs, baseline all- all-cause office visit counts, inpatient counts, baseline COPD cause office visit costs, baseline baseline all-cause total costs, office visit counts, baseline all-cause other outpatient visit baseline all-cause medical COPD outpatient counts, costs, baseline COPD outpatient costs, baseline all-cause baseline all-cause total costs, counts inpatient costs, baseline all- baseline all-cause medical costs, cause other outpatient visit baseline all-cause inpatient costs costs, baseline all-cause other outpatient visit costs

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Demographics: Female, age, region of residence, Medicare Advantage, health plan type, index treating provider specialty and index year (2014-17) Baseline Comorbid Conditions: Elixhauser comorbidity index score, Anxiety, Diabetes mellitus, Dyspnea, Chronic sinusitis, Congestive heart failure, Ischemic heart disease, Angina Pectoris, Hypertension, Pneumonia, Acute ischemic heart disease, Peripheral vascular disease, Ischemic stroke, Myocardial infarction, Renal Disease, Osteoporosis, Obstructive Sleep Apnea Original List of Covariates Baseline COPD severity proxies: Severe exacerbation counts, moderate exacerbation counts, exacerbation counts, moderate exacerbation for episode costs, exacerbation episode costs Consideration Baseline Utilization / Costs: all-cause inpatient use, all-cause office visit use, all-cause ED use, all-cause other outpatient visit use, all-cause ED costs, all-cause ED counts, all-cause inpatient costs, all-cause inpatient counts, all-cause office visit costs, all-cause office visit counts, all-cause other outpatient visit costs, COPD outpatient costs, all-cause outpatient counts, all-cause SNF costs, all-cause medical costs, all- cause pharmacy costs, all-cause total costs, COPD ED costs, COPD ED use, COPD ED visit counts, COPD inpatient costs, COPD inpatient counts, COPD inpatient use, COPD office visit counts, COPD office visit costs, COPD office visit use, COPD other outpatient use, COPD outpatient counts, COPD SNF costs, COPD total medical costs, COPD pharmacy costs, COPD total costs COPD=chronic obstructive pulmonary disease; ED=emergency department; SNF=skilled nursing facility

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Supplementary Table 5a – Unadjusted all-cause and COPD-related healthcare encounters over follow-up for GOLD A/B and C/D risk groups

GOLD A/B GOLD C/D Place of service, Compliant Non-compliant Compliant Non-compliant per-patient-year n = 12,631 n = 25,751 n = 3,852 n = 2,683

All-Cause HRU Inpatient, n (%) 3,441 (27.24)* 7,424 (28.83) 1,510 (39.20)* 1,328 (49.50) Count, mean (SD) 0.50 (1.20)* 0.55 (1.27) 0.83 (1.58)* 1.12 (1.87) 30-day readmission, n (%) 596 (4.72)* 1,395 (5.42) 337 (8.75)* 302 (11.26) Count, mean (SD) 0.08 (0.51)* 0.10 (0.54) 0.16 (0.72)* 0.22 (0.85) ED, n (%) 3,102 (24.56)* 6,623 (25.72) 1,193 (30.97)* 955 (35.59) Count, mean (SD) 0.41 (0.96)* 0.45 (1.09) 0.59 (1.26)* 0.75 (1.46) Office visits, n (%) 12,344 (97.73)* 24,985 (97.03)* 3,746 (97.25) 2,605 (97.09) Count, mean (SD) 10.69 (8.21) 10.68 (8.38) 12.35 (8.98) 12.21 (8.90) Other outpatient visits, n (%) 12,440 (98.49)* 25,217 (97.93) 3,812 (98.96) 2,648 (98.70) Count, mean (SD) 28.85 (33.38)* 29.94 (36.44) 36.69 (38.06)* 37.72 (38.95) COPD-Related HRU

Inpatient, n (%) 2,983 (23.62)* 6,412 (24.90) 1,455 (37.77)* 1,267 (47.22) Count, mean (SD) 0.39 (0.98)* 0.42 (1.04) 0.75 (1.45)* 1.01 (1.72) 30-day readmission, n (%) 409 (3.24) 888 (3.45) 277 (7.19)* 255 (9.50) Count, mean (SD) 0.05 (0.35)* 0.06 (0.37) 0.13 (0.60)* 0.18 (0.72) ED, n (%) 1,677 (13.28) 3,559 (13.82) 869 (22.56)* 691 (25.75) Count, mean (SD) 0.19 (0.61)* 0.20 (0.61)* 0.39 (0.96)* 0.49 (1.11) Office visits, n (%) 10,775 (85.31)* 21,179 (82.25) 3,525 (91.51)* 2,379 (88.67) Count, mean (SD) 3.1 (2.88)* 3.0 (2.83) 5.0 (3.78)* 4.8 (3.93) Other outpatient visits, n (%) 10,141 (80.29)* 20,347 (79.01) 3,527 (91.56) 2,411 (89.86) Count, mean (SD) 7.9 (14.63)* 8.2 (14.45) 15.8 (20.78)* 16.2 (21.82) * Significantly different with p-value <0.05 vs. corresponding non-compliant group COPD=chronic obstructive pulmonary disease; ED=emergency department; GOLD = Global Initiative for Chronic Obstructive Lung Disease; SD=standard deviation

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Supplementary Table 5b – Unadjusted all-cause and COPD-related costs over follow-up for GOLD A/B and C/D risk groups

GOLD A/B GOLD C/D Place of service, Compliant Non-compliant Compliant Non-compliant per-patient-year n = 12,631 n = 25,751 n = 3,852 n = 2,683

All-Cause Costs, mean (SD) Medical $19,390 ($46,607)* $19,997 ($58,866) $26,936 ($64,792) $27,198 ($60,136) Inpatient $8,902 ($33,442)* $9,621 ($47,357) $14,557 ($56,037) $15,022 ($48,811) ED $679 ($2,328)* $748 ($2,544) $1,009 ($3,091)* $1,167 ($2,887) Office visits $1,457 ($2,426) $1,447 ($3,013) $1,613 ($2,564) $1,577 ($2,446) Other outpatient $7,968 ($26,358)* $7,730 ($28,128) $9,234 ($22,117) $8,716 ($26,130) visits Other medicala $385 ($3,374)* $452 ($3,718) $522 ($3,767)* $717 ($4,758) Pharmacy $7,317 ($12,988)* $6,762 ($12,576) $8,749 ($13,229)* $6,438 ($11,825) Total $26,707 ($49,421) $26,759 ($61,500) $35,685 ($67,641)* $33,636 ($62,669)

COPD-Related Costs, mean (SD)

Medical $11,061 ($35,175)* $11,767 ($51,832) $19,089 ($58,244)* $21,313 ($52,809) Inpatient $8,111 ($32,647)* $8,913 ($50,078) $14,377 ($55,943)* $16,497 ($50,558) ED $354 ($1,638)* $378 ($1,679) $711 ($2,587)* $805 ($2,306) Office visits $327 ($314)* $313 ($328) $512 ($427)* $470 ($419) Other outpatient $2,057 ($8,639)* $1,925 ($8,380) $3,168 ($7,613) $3,092 ($6,340) visits Other medicala $212 ($2,554)* $237 ($2,553) $321 ($3,055)* $448 ($3,385)

Pharmacy $2,983 ($2,166)* $2,542 ($2,306) $4,105 ($2,963)* $2,353 ($2,366)

Total $14,043 ($35,241) $14,309 ($51,865) $23,194 ($58,217) $23,665 ($52,883)

* Significantly different with p-value <0.05 vs. corresponding non-compliant group a Other medical costs include skilled nursing facility costs COPD=chronic obstructive pulmonary disease; ED=emergency department; GOLD = Global Initiative for Chronic Obstructive Lung Disease; SD=standard deviation

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