Time-to-first exacerbation, adherence, and medical costs among US patients receiving umeclidinium/vilanterol or tiotropium as initial maintenance therapy for chronic obstructive pulmonary disease: a retrospective cohort study

BMC Pulmonary Medicine

Mei Sheng Duh¹  Qin Shen²  Malena Mahendran³  François Laliberté³  Guillaume Germain³  Riju Ray⁴  David Slade⁴  Chad Moretz⁵  Beth Hahn⁵ 

[1] Analysis Group, Inc, Boston, MA, USA;Global Value Evidence and Outcomes, GSK, Collegeville, PA, USA;Groupe D’Analyse, Ltée, Montreal, QC, Canada;US Medical Affairs, GSK, Research Triangle Park, NC, USA;US Value Evidence & Outcomes, Medical Affairs, GSK, Research Triangle Park, NC, USA;

关键词: Chronic obstructive pulmonary disease;    Exacerbation;    Initial maintenance therapy;    LAMA/LABA;    Medication adherence;    Medical costs;   

DOI  :  10.1186/s12890-021-01612-5

来源: Springer

【 摘 要 】

BackgroundAdherence to chronic obstructive pulmonary disease (COPD) maintenance medication is important for managing symptoms and exacerbation risk, and is associated with reduced mortality, hospitalizations, and costs. This study compared on-treatment exacerbations, medical costs, and medication adherence in patients with COPD initiating treatment with umeclidinium/vilanterol (UMEC/VI) or tiotropium (TIO).MethodsThis retrospective matched cohort study selected patients from Optum’s de-identified Clinformatics Data Mart database who initiated maintenance treatment with UMEC/VI or TIO between 01/01/2014 and 12/31/2017 (index date defined as the first dispensing). Eligible patients were ≥ 40 years of age and had ≥ 12 months continuous health plan coverage pre- and post-index; ≥ 1 medical claim for COPD pre-index or on the index date; no moderate/severe COPD-related exacerbations on the index date; no asthma diagnosis pre- or post-index; no maintenance medication fills containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists pre-index or on the index date; and no fills for both UMEC/VI and TIO on the index date. Outcomes included time-to-first (Kaplan–Meier analysis) and rates of on-treatment COPD-related moderate/severe exacerbations, medication adherence (proportion of days covered [PDC] and proportion of adherent patients [PDC ≥ 0.8]), and COPD-related medical costs per patient per month (PPPM). Propensity score matching was used to adjust for potential confounders.ResultsEach cohort included 3929 matched patients. Kaplan–Meier rates of on-treatment COPD-related exacerbations were similar between cohorts (hazard ratio at 12 months; overall: 0.93, moderate: 0.92, severe: 1.07; all p > 0.05). UMEC/VI versus TIO initiators had significantly higher adherence (mean PDC: 0.44 vs 0.37; p < 0.001; proportion with PDC ≥ 0.8: 22.0% vs 16.4%; p< 0.001) and significantly lower mean on-treatment COPD-related total medical costs ($867 vs $1095 PPPM; p = 0.028), driven by lower outpatient visit costs.ConclusionsThese findings provide valuable information for physicians considering UMEC/VI or TIO as initial maintenance therapy options for patients with COPD.

【 授权许可】

CC BY