Comparison of COPD health care utilization and associated costs across patients treated with LAMA+LABA fixed-dose therapies

• Main Authors: Bengtson, L.G.S (Author), Chastek, B. (Author), Palli, S.R (Author), Xie, B. (Author)
• Format: Article
• Language: English
• Published: Academy of Managed Care Pharmacy (AMCP) 2021
• Subjects: aclidinium bromide; aclidinium bromide plus formoterol fumarate; Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; age; aged; Aged; antibiotic agent; Article; benzoxazine derivative; Benzoxazines; benzyl alcohol derivative; Benzyl Alcohols; beta 2 adrenergic receptor stimulating agent; bibliographic database; bronchodilating agent; Bronchodilator Agents; chlorobenzene; Chlorobenzenes; chronic obstructive lung disease; clinical outcome; cohort analysis; comparative study; consultation; corticosteroid; data analysis software; delayed release formulation; Delayed-Action Preparations; disease exacerbation; drug combination; Drug Combinations; economics; emergency health service; emergency ward; female; Female; follow up; formoterol fumarate plus glycopyrronium bromide; glycopyrronium bromide plus indacaterol; health care cost; health care utilization; health insurance; hospital patient; human; Humans; inhalational drug administration; length of stay; long acting drug; maintenance therapy; major clinical study; male; Male; medicare; middle aged; Middle Aged; monotherapy; Muscarinic Antagonists; muscarinic receptor blocking agent; observational study; olodaterol plus tiotropium bromide; outpatient care; oxygen; oxygen therapy; Patient Acceptance of Health Care; patient attitude; pharmacy (shop); practice guideline; propensity score; Pulmonary Disease, Chronic Obstructive; quinuclidine derivative; Quinuclidines; Retrospective Studies; retrospective study; sex factor; statistical analysis; tiotropium bromide; Tiotropium Bromide; tiotropium-olodaterol; umeclidinium; umeclidinium plus vilanterol; United States; vilanterol
• Online Access: View Fulltext in Publisher

 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:    89 vs.    68, P = 0.003; vs. UMEC + VI:    85 vs.    45, P = 0.027) and 4.56% and 5.67% lower mean annualized per-patient pharmacy spending (vs. other LAMA + LABAs:    ,570 vs.    ,741, P< 0.001; vs. UMEC + VI:    ,556 vs.    ,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:    55 vs.    71, P< 0.001; vs. UMEC + VI:    49 vs.    30, P< 0.001), and 10.86% lower mean annualized per-patient outpatient setting costs (vs. UMEC + VI:    ,348 vs.    ,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.