Observational study on the impact of initiating tiotropium alone versus tiotropium with fluticasone propionate/salmeterol combination therapy on outcomes and costs in chronic obstructive pulmonary disease

Respiratory Research

Anand A Dalal³  Glenn Crater³  Benno Bechtel³  Anna O D'Souza¹  Manan Shah¹  Arjun Chatterjee² 

[1] Data Analytics and Insights, Xcenda; 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, USA;Department of Internal Medicine, Wake Forest University School of Medicine; Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA;US Health Outcomes, GlaxoSmithKline; 5 Moore Dr, Bide West, Mail Stop B.3153, Research Triangle Park, NC 27709, USA

关键词: triple therapy;    add-on therapy;    exacerbation;    pharmacotherapy;    emergency room visit;    hospitalization;    cost;    pharmacoeconomics;    chronic obstructive pulmonary disease;   

Others  :  796747
DOI  :  10.1186/1465-9921-13-15

 received in 2011-06-15, accepted in 2012-02-17,  发布年份 2012

【 摘 要 】

Background

This retrospective cohort study compared the risks of exacerbations and COPD-related healthcare costs between patients with chronic obstructive pulmonary disease (COPD) initiating tiotropium (TIO) alone and patients initiating triple therapy with fluticasone-salmeterol combination (FSC) added to TIO.

Methods

Managed-care enrollees who had an index event of ≥ 1 pharmacy claim for TIO during the study period (January 1, 2003-April 30, 2008) and met other eligibility criteria were categorized into one of two cohorts depending on their medication use. Patients in the TIO+FSC cohort had combination therapy with TIO and FSC, defined as having an FSC claim on the same date as the TIO claim. Patients in the TIO cohort had no such FSC use. The risks of COPD exacerbations and healthcare costs were compared between cohorts during 1 year of follow-up.

Results

The sample comprised 3333 patients (n = 852 TIO+FSC cohort, n = 2481 TIO cohort). Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation (hazard ratio 0.772; 95% confidence interval [CI] 0.641, 0.930) and any exacerbation (hazard ratio 0.763; 95% CI 0.646, 0.949) and a nonsignificant reduction in COPD-related adjusted monthly medical costs.

Conclusions

Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation and any exacerbation over a follow-up period of up to 1 year. These improvements were gained with triple therapy at roughly equal cost of that of TIO alone.

【 授权许可】

   
2012 Chatterjee et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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