Observational study of the outcomes and costs of initiating maintenance therapies in patients with moderate exacerbations of COPD

Abstract

BackgroundThere are limited data describing patients with moderate COPD exacerbations and evaluating comparative effectiveness of maintenance treatments in this patient population. The study examined COPD patients with moderate COPD exacerbations. COPD-related outcomes were compared between patients initiating fluticasone propionate-salmeterol 250/50 mcg (FSC) vs anticholinergics (ACs) following a moderate COPD exacerbation.MethodsThis retrospective observational study used a large administrative claims database (study period: 2003–2009) to identify and describe patients with an initial, moderate COPD exacerbation. A descriptive analysis of patients with moderate COPD exacerbations was done evaluating maintenance treatment rates, subsequent COPD exacerbation rates, and COPD-related costs during a 1-year period. A cohort analysis compared COPD exacerbation rates and associated costs during a variable-length follow-up period between patients initiating maintenance therapy with FSC or ACs. COPD exacerbations were reported as rate per 100 patient-years, and monthly costs were reported (standardized to USD 2009). COPD exacerbation rates between cohorts were evaluated using Cox proportional hazards models, and costs were analyzed using generalized linear models with log-link and gamma distribution.Results21,524 patients with a moderate COPD exacerbation were identified. Only 25% initiated maintenance therapy, and 13% had a subsequent exacerbation. Annual costs averaged $594 per patient. A total of 2,849 treated patients (FSC = 925; AC = 1,924) were eligible for the cohort analysis. The FSC cohort had a significantly lower rate of COPD exacerbations compared to the AC cohort (20.8 vs 32.8; P = 0.04). After adjusting for differences in baseline covariates, the FSC cohort had a 42% significantly lower risk of a COPD exacerbation (HR = 0.58; 95% CI: 0.38, 0.91). The FSC cohort incurred significantly higher adjusted pharmacy costs per patient per month by $37 (95% CI: $19, $72) for COPD-related medications vs the AC cohort. However, this increase was offset by a significant reduction in adjusted monthly medical costs per patient for the FSC vs the AC cohort ($82 vs $112; P < 0.05). Total monthly COPD-related costs, as a result, did not differ between cohorts.ConclusionsOnly a quarter of patients with a moderate COPD exacerbation were subsequently treated with maintenance therapy. Initiation of FSC among those treated was associated with better clinical and economic outcomes compared to AC.

Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

“…Similar high prescription rates of ICS/LABA in COPD patients have been found in previous studies [ 5 , 6 ] and lower rates in others [ 12 , 13 ]. Although the use of ICS/LABA is recommended in subgroups of COPD patients, to our knowledge, no one has described the characteristics of patients who are prescribed this combination by their GP in real clinical practice.…”

Inhaled therapies for chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…This is in-line with our meta-analysis results showing that there was no statistically significant difference between LABA+ICS and LAMA in short-term treatment. In longer-term observational studies, LABA+ICS proved more effective at reducing exacerbations than LAMA 32 33 ; however, in our meta-analysis there was no statistically significant difference between the two treatments in the long-term, though LABA+ICS was ranked higher than LAMA in SUCRA analysis. With a variable follow-up period, up to 1 year with a median of 20 weeks, Chatterjee et al 34 found triple therapy significantly more effective at reducing exacerbations than LAMA.…”

“…Dalal et al 31 (n=4150) found that the number of exacerbations resulting in outpatient visits or rehospitalisation was no different between patients taking LABA+ICS and those taking LAMA within 30 days of an initial COPD-related hospitalisation. Dalal et al 32 (n=2849) found that in the 1-year period following a moderate exacerbation, patients taking LABA+ICS experienced a significantly lower risk of exacerbation than those taking LAMA. Dalal et al 33 (n=4001) similarly found a lower risk of exacerbation and lower exacerbation-related hospitalisation rates in patients with COPD with comorbid depression/anxiety taking LABA+ICS compared with those taking LAMA.…”

Development and Validation of a Healthcare Utilization-Based Algorithm to Identify Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…In addition, the prevalence of diagnosis and procedure codes, as well as healthcare utilization data commonly used to define COPD and AECOPD events, were tabulated for the observation period. Based on the research team's expertise in data related to COPD, previously published algorithms [19][20][21][22][23][24][25] were modified to develop separate algorithms to identify "moderate" and "severe" AECOPD events in administrative data. Of the potential AECOPD events identified with the utilization-based algorithms, random samples of 550 (300 moderate and 250 severe) were selected for detailed medical chart review to validate whether the potential AECOPD was a true event.…”