Patient Characteristics and Healthcare Resource Utilization Among Patients with COPD New to LAMA/LABA Fixed-Dose Combination Treatment in US-Based Real-World Practice

Int J Chron Obstruct Pulmon Dis. 2020 Apr 16:15:775-786. doi: 10.2147/COPD.S238408. eCollection 2020.

Abstract

Introduction: This retrospective, observational cohort study utilized an integrated dataset from an electronic health records system and a claims database to describe demographic and clinical characteristics, healthcare resource utilization (HCRU), and treatment patterns in COPD patients initiating long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) fixed-dose combination (FDC) treatment in the USA.

Methods: Patients were aged ≥40 years and had a COPD diagnosis (Practice Fusion system) and ≥1 prescription of LAMA/LABA FDC therapy, with an index date (first prescription) 1 May 2014-31 December 2017. For the HCRU analysis, patients had ≥2 claims from the Symphony Health database within 12 months before index. All analyses of outcomes relating to demographic and clinical characteristics, HCRU, and treatment patterns were descriptive.

Results: Patients initiating LAMA/LABA FDCs (n=8224) had a mean age of 67.9 years, 52.8% were female, and mean BMI was 29.2 kg/m2. The most common comorbidities were cardiovascular disease (74.3%), hypertension (64.0%), and hyperlipidemia (45.6%). In the 12 months prior to index, 53.1% of patients had used inhaled therapy: 23.4% short-acting therapy only, 16.7% short-acting and maintenance therapy, and 13.1% maintenance therapy only. Amongst users of inhaled therapies, the pMDI was the most frequently used device (64.3%, n=2812/4370). Of 7050 patients included in the HCRU analysis, 79.8% had COPD-related costs; mean cost/patient was $4174. Mean COPD-related costs per patient for moderate and severe exacerbations were $910 and $23,208, respectively. Per-patient costs included $23,032 for inpatient visits, $2358 for emergency visits, $4432 for outpatient visits, and $1989 for pharmacy claims.

Conclusion: This observational study is the first to describe the real-world demographic and clinical characteristics and HCRU of patients initiating LAMA/LABA FDC treatment in the USA. Patients were generally elderly and overweight, with comorbidities of CVD, hypertension, and hyperlipidemia. Inpatient visits were the largest contributor to COPD-related costs per patient in the year prior to initiation of LAMA/LABA FDCs.

Keywords: cost; demographic characteristics; disease characteristics; muscarinic antagonist; β2-agonist.

Publication types

  • Observational Study

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Aged
  • Bronchodilator Agents / therapeutic use
  • Delivery of Health Care
  • Female
  • Humans
  • Male
  • Muscarinic Antagonists* / therapeutic use
  • Pulmonary Disease, Chronic Obstructive* / drug therapy
  • Pulmonary Disease, Chronic Obstructive* / epidemiology
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Muscarinic Antagonists

Grants and funding

This study was supported by AstraZeneca. Employees of the sponsor were involved in various aspects of the conception and design of the studies, acquisition of data, analysis and interpretation of data, and input into manuscript development. The sponsor did not place any restrictions on the authors about the statements made in the final article.