<p>Patient Characteristics and Healthcare Resource Utilization Among Patients with COPD New to LAMA/LABA Fixed-Dose Combination Treatment in US-Based Real-World Practice</p>

Abstract

Introduction: This retrospective, observational cohort study utilized an integrated dataset from an electronic health records system and a claims database to describe demographic and clinical characteristics, healthcare resource utilization (HCRU), and treatment patterns in COPD patients initiating long-acting muscarinic antagonist (LAMA)/long-acting β 2 -agonist (LABA) fixed-dose combination (FDC) treatment in the USA. Methods: Patients were aged ≥40 years and had a COPD diagnosis (Practice Fusion system) and ≥1 prescription of LAMA/LABA FDC therapy, with an index date (first prescription) 1 May 2014-31 December 2017. For the HCRU analysis, patients had ≥2 claims from the Symphony Health database within 12 months before index. All analyses of outcomes relating to demographic and clinical characteristics, HCRU, and treatment patterns were descriptive. Results: Patients initiating LAMA/LABA FDCs (n=8224) had a mean age of 67.9 years, 52.8% were female, and mean BMI was 29.2 kg/m 2 . The most common comorbidities were cardiovascular disease (74.3%), hypertension (64.0%), and hyperlipidemia (45.6%). In the 12 months prior to index, 53.1% of patients had used inhaled therapy: 23.4% short-acting therapy only, 16.7% short-acting and maintenance therapy, and 13.1% maintenance therapy only. Amongst users of inhaled therapies, the pMDI was the most frequently used device (64.3%, n=2812/4370). Of 7050 patients included in the HCRU analysis, 79.8% had COPDrelated costs; mean cost/patient was $4174. Mean COPD-related costs per patient for moderate and severe exacerbations were $910 and $23,208, respectively. Per-patient costs included $23,032 for inpatient visits, $2358 for emergency visits, $4432 for outpatient visits, and $1989 for pharmacy claims. Conclusion: This observational study is the first to describe the real-world demographic and clinical characteristics and HCRU of patients initiating LAMA/LABA FDC treatment in the USA. Patients were generally elderly and overweight, with comorbidities of CVD, hypertension, and hyperlipidemia. Inpatient visits were the largest contributor to COPD-related costs per patient in the year prior to initiation of LAMA/LABA FDCs.

Characteristics of initiators of budesonide/glycopyrrolate/formoterol for treatment of chronic obstructive pulmonary disease (COPD) in the United States: the AURA study

“…In general, the clinical characteristics of patients with COPD who initiated BGF in this AURA study were similar to patients who initiated FUV or MITT, as reported in previous studies, 12 , 18 with the majority being 65 years or older, female, and Medicare beneficiaries. Consistent with findings of these two previous studies describing patients initiating FUV and MITT, 11 , 12 a high proportion of patients initiating BGF in our study had cardiopulmonary-related comorbidities, indicating that the presence of such comorbidities may also play a role in prescribing decisions of TT in real-world practice.…”

Real-World Healthcare Resource Utilization and Cost Burden Assessment for Adults With Generalized Myasthenia Gravis in the United States

“…Mean 1-year per-patient all-cause costs from IDV® in 10,140 patients with epilepsy without tuberculosis sclerosis complex was reported to be $56,397 ( 24 ), while total cost over 5 years was reported at $47,464 (average of $9492.80 per year) for 15,599 patients with rheumatoid arthritis who used oral methotrexate only ( 25 ). For 7043 patients with chronic obstructive pulmonary disease, 1-year all-cause costs from IDV® were reported at $19,690.40 ( 26 ). Though direct comparisons cannot be made due to non-trivial differences in cost estimation algorithms (i.e., charged vs. paid amounts), it is apparent that costs for gMG lie in the higher range within these relatively age-matched chronic conditions, with exacerbations and crisis events causing costs to rise even further.…”

Healthcare resource utilization and exacerbations in patients with chronic obstructive pulmonary disease treated with nebulized glycopyrrolate in the USA: a real-world data analysis

“…Prior to initiating nebulized GLY, one in five patients had chronic respiratory failure, one in four patients had influenza or respiratory infection, and nearly one in three patients had a CCI score of at least 3. Compared to other COPD studies using U.S. claims data, higher proportions of patients in this study used ICS (31% versus 3% to 21.6% [24][25][26][27][28] ) OCS (69% versus 14% to 49% 25,27,29,30 ) SABA (65% versus 20% to 54% [25][26][27][29][30][31] ) or SAMA (10% versus 1% to 8% [25][26][27]29 ) during the pre-index period. As corticosteroids (ICS or OCS), shortacting agents (SAMA or SABA), and antibiotics are treatment options for the treatment of acute exacerbations 6 , the high use of these therapies during the pre-index period suggests a population with a history of exacerbations, which is a risk factor for future exacerbations 7 .…”