Validation of a New Risk Measure for Chronic Obstructive Pulmonary Disease Exacerbation Using Health Insurance Claims Data

Stanford, Richard H.; Nag, Arpita; Mapel, Douglas W.; Lee, Todd A.; Rosiello, Richard; Vekeman, Francis; Gauthier‐Loiselle, Marjolaine; Duh, Mei Sheng; Merrigan, J F Philip; Schatz, Michael

doi:10.1513/annalsats.201508-493oc

Cited by 18 publications

(18 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 8 A retrospective claims-based study of patients with COPD diagnoses showed a relationship between filled prescriptions for rescue medications and exacerbations over 1 year of follow-up. 10 In addition, a prospective 3-month study demonstrated greater dyspnea among patients with COPD who overused their rescue medication, 9 and in a post hoc analysis of another study comparing B/F with formoterol, greater rescue medication use at 2 months was associated with a significant increase in exacerbation risk at 10 months in patients with moderate to very severe COPD. 11 Our finding that patients initiating UMEC/VI had better adherence and used less rescue medication, therefore, supports the suggestion that UMEC/VI treatment provided better symptom control and may improve outcomes for non-exacerbating patients with COPD compared with B/F.…”

Section: Discussionmentioning

confidence: 99%

<p>Evaluation of Medication Adherence and Rescue Medication Use in Non-Exacerbating Patients with COPD Receiving Umeclidinium/Vilanterol or Budesonide/Formoterol as Initial Maintenance Therapy</p>

Moretz

Cole

et al. 2020

COPD

View full text Add to dashboard Cite

Background Adherence to inhaled maintenance therapy is critical to managing chronic obstructive pulmonary disease (COPD), while increasing rescue medication usage may indicate worsening symptoms. This study evaluated adherence and rescue medication use in patients with COPD without a history of exacerbation who initiated combination therapy with budesonide/formoterol (B/F) or umeclidinium/vilanterol (UMEC/VI). Methods Retrospective observational study of commercially insured and Medicare Advantage with Part D enrollees who initiated UMEC/VI or B/F between January 1, 2014 and December 31, 2017 (earliest fill defined as index date). Eligibility criteria included age ≥40 years, 12 months continuous enrollment pre- and post-index, ≥1 pre-index COPD diagnosis, no pre-index asthma diagnosis, COPD-related exacerbations, or medication fills containing inhaled corticosteroids, long-acting β 2 -agonists, or long-acting muscarinic antagonists. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups on potential confounders. Medication adherence (primary endpoint) was evaluated by the proportion of days covered (PDC). Rescue medication use (secondary endpoint) was standardized to canister equivalents (1 metered dose inhaler [200 puffs] or ~100 nebulized doses of short-acting β 2 -agonist- and/or short-acting muscarinic agonist-containing medication). Results After IPTW, covariates were balanced between cohorts (UMEC/VI: N=4082; B/F: N=9529). UMEC/VI initiators had a significantly greater mean PDC (UMEC/VI: 0.47 [0.33]; B/F: 0.38 [0.30]; P <0.001) and significantly higher rates of adherence (PDC≥0.80) than B/F initiators (UMEC/VI: n=1004 [25%], B/F: n=1391 [15%]; relative risk: 1.68, 95% CI: 1.57, 1.81; P <0.001). In the year following initiation, UMEC/VI initiators filled significantly fewer rescue medication canister equivalents than B/F initiators (predicted mean [95% CI]: 1.78 [1.69, 1.88] vs 2.15 [2.08, 2.23]; mean difference [95% CI]: −0.37 [−0.50, −0.24]; P <0.001), corresponding to 17% less (estimated) rescue medication use (incidence rate ratio [95% CI]: 0.83 [0.78, 0.88]). Conclusion Among non-exacerbating patients with COPD initiating dual therapy, UMEC/VI demonstrated improved adherence and reduced rescue medication use compared with B/F.

show abstract

Section: Discussionmentioning

confidence: 99%

<p>Evaluation of Medication Adherence and Rescue Medication Use in Non-Exacerbating Patients with COPD Receiving Umeclidinium/Vilanterol or Budesonide/Formoterol as Initial Maintenance Therapy</p>

Moretz

Cole

et al. 2020

COPD

View full text Add to dashboard Cite

show abstract

“…Database studies are vulnerable to inaccuracies in data collection and a lack of certain patient-specific data elements (Ruettermann, 2018). Although the MarketScan® databases have been repeatedly shown to be accurate and to have high utility for health services studies (Karhade et al., 2018; Rahgozar et al., 2017; Stanford et al., 2016), the reliance of this study on a database is an inherent weakness. We were unable to identify the severity of CMC disease in each patient, which could affect the results (e.g.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroid or hyaluronic acid injections to the carpometacarpal joint of the thumb joint are associated with early complications after subsequent surgery

Giladi

Rahgozar

Zhong

et al. 2018

J Hand Surg Eur Vol

View full text Add to dashboard Cite

Truven MarketScan® Databases were used to identify patients with thumb carpometacarpal arthritis who underwent surgical treatment. Pre-operative corticosteroid or hyaluronic acid injections were identified, as were post-operative complications. Multivariable regressions assessed the relationship between injections and complications. Of 16,268 patients, 4462 had steroid injections and 252 received hyaluronic acid injections. Twenty-one per cent (3381 patients) had post-operative complications. Diabetes and smoking increased the odds of complications in all models. Odds of any complication, most notably infectious complications, were increased 20% by corticosteroids (OR 1.2; 95% CI: 1.1 to 1.3). More than three injections increased the odds of a complication by 70% (OR 1.7; 95% CI: 1.3 to 2.1). Hyaluronic acid increased the odds of wound-healing complications by 110% (OR 2.1; 95% CI: 1.3 to 3.4). Corticosteroid and hyaluronic acid injections for thumb carpometacarpal arthritis increase the odds of post-operative complications. Level of evidence: IV

show abstract

“…Proportion of Days Covered (PDC) was calculated to assess treatment adherence [15,16]. PDC is a commonly used proxy for medication adherence and is calculated by dividing the total number of days which medication was available, based on filled prescriptions, by the length of each subject's observation time [15].…”

Section: Measures and Outcomesmentioning

confidence: 99%

“…The COPD Treatment Ratio (CTR) in the follow-up period was also assessed. CTR is a validated measure of exacerbation risk using pharmacy claims data and is calculated by dividing the number of prescription claims for COPD controller medications by the number of prescription claims for both maintenance medication and rescue medications (short acting betaagonist or short acting muscarinic antagonists or combinations) [16]. Medications used in the CTR are reported in the Appendix.…”

Section: Measures and Outcomesmentioning

confidence: 99%

Assessment of COPD-related outcomes in patients initiating a once daily or twice daily ICS/LABA

Stanford

Parker

Reinsch

et al. 2019

Respiratory Medicine

Self Cite

View full text Add to dashboard Cite

Background: Use of inhaled corticosteroids and long acting beta agonist (ICS/LABA) combination therapy has been shown to decrease the frequency of exacerbations in patients with chronic obstructive pulmonary disease (COPD). In this population, adherence to treatment is associated with better disease control and lower risk of COPD-related exacerbations in the future. Using a treatment with a more convenient regimen or easier-to-use device could improve patient adherence, improve disease control, decrease the frequency of exacerbations and minimize the COPD-related economic burden. Real-world information on the impact on healthcare costs and exacerbation risk of initiating once-daily or twice daily ICS/LABA in this patient population is limited.The objective of this study was to assess COPD-related healthcare costs, adherence, and exacerbations in COPD patients initiating treatment with fluticasone furoate/vilanterol 100/25 (FF/VI) or budesonide/formoterol 160/4.5 (BUD/F) using a large managed care database in the US. Methods: This was a retrospective cohort study among COPD patients initiating FF/VI or BUD/F between January 01, 2014 and June 30, 2016. The analysis used the Optum Research Database (ORD) which contains patients from commercial and Medicare Advantage Prescription Drug (MAPD) plans. The study included new initiators of ICS/LABA as either FF/VI or BUD/F for COPD, ≥40 years of age at index, ≥15 months of continuous enrollment (12 months pre-index and ≥3 months post-index). New users of FF/VI or BUD/F were matched on baseline characteristics using propensity score matching (PSM) methods. Multivariate models including ordinary least squares regression, Lin's regression, logistic regression, and Cox proportional hazards were used to assess differences between the cohorts on outcomes of interest. Results: A total of 18,652 subjects met all inclusion and exclusion criteria with 5044 initiating FF/VI and 13,608 initiating BUD/F. Of these, 9026 subjects were matched at a 1:1 ratio (4513 patients in each cohort) and were included in the final analyses.

show abstract

Validation of a New Risk Measure for Chronic Obstructive Pulmonary Disease Exacerbation Using Health Insurance Claims Data

Abstract: The ratio of controller to total medications dispensed for COPD is a measure that can easily be calculated using only pharmacy claims data. A CTR of greater than or equal to 0.3 can potentially be used as a quality-of-care measurement for prevention of exacerbations.

Cited by 18 publications

References 22 publications

<p>Evaluation of Medication Adherence and Rescue Medication Use in Non-Exacerbating Patients with COPD Receiving Umeclidinium/Vilanterol or Budesonide/Formoterol as Initial Maintenance Therapy</p>

<p>Evaluation of Medication Adherence and Rescue Medication Use in Non-Exacerbating Patients with COPD Receiving Umeclidinium/Vilanterol or Budesonide/Formoterol as Initial Maintenance Therapy</p>

Corticosteroid or hyaluronic acid injections to the carpometacarpal joint of the thumb joint are associated with early complications after subsequent surgery

Assessment of COPD-related outcomes in patients initiating a once daily or twice daily ICS/LABA

Contact Info

Product

Resources

About