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07343nam a2201225Ia 4500 |
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10.18553-JMCP.2021.20514 |
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|a 23760540 (ISSN)
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|a Comparison of COPD health care utilization and associated costs across patients treated with LAMA+LABA fixed-dose therapies
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|b Academy of Managed Care Pharmacy (AMCP)
|c 2021
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|z View Fulltext in Publisher
|u https://doi.org/10.18553/JMCP.2021.20514
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|a BACKGROUND: There is limited clinical trial and/or real-world evidence comparing differences among currently approved fixed-dose combination (FDC) long-Acting muscarinic antagonist (LAMA)/long-Acting beta2-Agonist (LABA) treatments. OBJECTIVE: To compare chronic obstructive pulmonary disease (COPD)-related and allcause health care resource utilization (HCRU) and costs between COPD patients initiating tiotropium (TIO) + olodaterol (OLO) versus (a) other LAMA + LABA FDCs and (b) umeclidinium (UMEC) + vilanterol (VI), specifically. METHODS: In this retrospective observational study, patients initiating fixed-dose LAMA + LABA therapy (earliest fill date = index date) between January 1, 2014, and September 30, 2018, were identified using administrative claims data from the Optum Research Database. Patients were followed post-index for 1-12 months. Follow-up was censored at the earliest occurrence of index therapy discontinuation or switch, health plan disenrollment, study end date, or reaching the maximum 12-month allowed duration. Propensity score matching of 1:2 was used to balance differences in baseline characteristics between cohorts for each of the 2 comparisons. Annualized population averages of HCRU and costs were calculated for each cohort as [sum of visits (or costs) for all individuals during the follow-up period] [sum of follow-up on-Treatment time for all individuals] × 365 days. RESULTS: After matching, compared with patients who initiated other LAMA + LABAs or UMEC + VI, patients who initiated TIO + OLO had 14.29% and 16.95% fewer mean annualized per-patient COPD-related emergency department (ED) visits (vs. other LAMA + LABAs: 0.49 vs. 0.59, P = 0.005; vs. UMEC + VI: 0.48 vs. 0.56, P = 0.026) and 3.07% and 3.14% fewer mean annualized per-patient pharmacy fills (vs. other LAMA + LABAs: 12.66 vs. 13.07, P = 0.016; vs. UMEC + VI: 12.62 vs. 13.02, P = 0.022), leading to 17.39% and 21.47% lower mean annualized per-patient COPD-related ED costs (vs. other LAMA + LABAs:
|2 89 vs.
|3 68, P = 0.003; vs. UMEC + VI:
|2 85 vs.
|3 45, P = 0.027) and 4.56% and 5.67% lower mean annualized per-patient pharmacy spending (vs. other LAMA + LABAs:
|3 ,570 vs.
|3 ,741, P< 0.001; vs. UMEC + VI:
|3 ,556 vs.
|3 ,770, P< 0.001) in the follow-up period. Similarly, patients in the TIO + OLO cohort had 15.63% and 21.17% fewer mean annualized per-patient all-cause ED visits (vs. other LAMA + LABAs: 1.08 vs. 1.37, P< 0.001; vs. UMEC + VI: 1.08 vs. 1.28, P = 0.001), 8.29% fewer mean annualized per-patient outpatient visits (vs. UMEC + VI: 13.28 vs. 14.48, P = 0.031), 3.41% fewer mean annualized per-patient pharmacy fills (vs. other LAMA + LABAs: 56.92 vs. 58.93, P = 0.028), 19.48% and 22.28% lower mean annualized perpatient all-cause ED costs (vs. other LAMA + LABAs:
|7 55 vs.
|9 71, P< 0.001; vs. UMEC + VI:
|7 49 vs.
|9 30, P< 0.001), and 10.86% lower mean annualized per-patient outpatient setting costs (vs. UMEC + VI:
|3 ,348 vs.
|3 ,756, P = 0.050). There were no statistically significant differences for the other outcome measures. CONCLUSIONS: In a real-world setting, differences in HCRU and costs were observed between FDC LAMA + LABAs, with patients initiating TIO + OLO having lower ED visits/costs, COPD-related pharmacy fills/ costs, and all-cause pharmacy use and outpatient visits/costs than those initiating other FDC LAMA + LABAs or UMEC + VI specifically. The remaining HCRU and cost measures were not significantly different. © 2021 Academy of Managed Care Pharmacy (AMCP). All rights reserved.
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|a aclidinium bromide
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|a aclidinium bromide plus formoterol fumarate
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|a Administration, Inhalation
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|a Adrenergic beta-2 Receptor Agonists
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|a age
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|a aged
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|a Aged
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|a antibiotic agent
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|a Article
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|a benzoxazine derivative
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|a Benzoxazines
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|a benzyl alcohol derivative
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|a Benzyl Alcohols
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|a beta 2 adrenergic receptor stimulating agent
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|a beta 2 adrenergic receptor stimulating agent
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|a bibliographic database
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|a bronchodilating agent
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|a bronchodilating agent
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|a Bronchodilator Agents
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|a chlorobenzene
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|a Chlorobenzenes
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|a chronic obstructive lung disease
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|a chronic obstructive lung disease
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|a clinical outcome
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|a cohort analysis
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|a comparative study
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|a comparative study
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|a consultation
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|a corticosteroid
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|a data analysis software
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|a delayed release formulation
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|a Delayed-Action Preparations
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|a disease exacerbation
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|a drug combination
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|a Drug Combinations
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|a economics
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|a emergency health service
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|a emergency ward
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|a female
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|a Female
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|a follow up
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|a formoterol fumarate plus glycopyrronium bromide
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|a glycopyrronium bromide plus indacaterol
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|a health care cost
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|a health care utilization
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|a health insurance
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|a hospital patient
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|a human
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|a Humans
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|a inhalational drug administration
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|a length of stay
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|a long acting drug
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|a maintenance therapy
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|a major clinical study
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|a male
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|a Male
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|a medicare
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|a middle aged
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|a Middle Aged
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|a monotherapy
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|a Muscarinic Antagonists
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|a muscarinic receptor blocking agent
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|a muscarinic receptor blocking agent
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|a observational study
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|a olodaterol plus tiotropium bromide
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|a outpatient care
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|a oxygen
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|a oxygen therapy
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|a Patient Acceptance of Health Care
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|a patient attitude
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|a pharmacy (shop)
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|a practice guideline
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|a propensity score
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|a Pulmonary Disease, Chronic Obstructive
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|a quinuclidine derivative
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|a Quinuclidines
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|a Retrospective Studies
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|a retrospective study
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|a sex factor
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|a statistical analysis
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|a tiotropium bromide
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|a Tiotropium Bromide
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|a tiotropium-olodaterol
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|a umeclidinium
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|a umeclidinium plus vilanterol
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|a United States
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|a United States
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|a vilanterol
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|a Bengtson, L.G.S.
|e author
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|a Chastek, B.
|e author
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|a Palli, S.R.
|e author
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|a Xie, B.
|e author
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|t Journal of Managed Care and Specialty Pharmacy
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