Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History
Sanjay Sethi,1 Brendan Clark,2 Lindsay GS Bengtson,3 Erin K Buysman,3 Swetha Palli,2 Andrew Sargent,3 Asif Shaikh,2 Gary T Ferguson4 1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; 2Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 3Optum L...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-04-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/healthcare-resource-utilization-cost-and-clinical-outcomes-in-patients-peer-reviewed-fulltext-article-COPD |
| _version_ | 1797843386295648256 |
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| author | Sethi S Clark B Bengtson LG Buysman EK Palli S Sargent A Shaikh A Ferguson GT |
| author_facet | Sethi S Clark B Bengtson LG Buysman EK Palli S Sargent A Shaikh A Ferguson GT |
| author_sort | Sethi S |
| collection | DOAJ |
| description | Sanjay Sethi,1 Brendan Clark,2 Lindsay GS Bengtson,3 Erin K Buysman,3 Swetha Palli,2 Andrew Sargent,3 Asif Shaikh,2 Gary T Ferguson4 1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; 2Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 3Optum Life Sciences, Eden Prairie, MN, USA; 4Department of Medicine, Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USACorrespondence: Brendan Clark, Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Road, Ridgefield, CT, 06877, USA, Email brendan.clark@boehringer-ingelheim.comBackground: ATS and GOLD guidelines recommend treating low-exacerbation risk COPD patients with dual (LAMA/LABA) agents and reserving triple therapy (TT; LAMA/LABA and inhaled corticosteroids [ICS]) for severe cases with higher-exacerbation risk. However, TT often is prescribed across the COPD spectrum. This study compared COPD exacerbations, pneumonia diagnosis, healthcare resource utilization, and costs for patients initiating tiotropium bromide/olodaterol (TIO/OLO) and a TT, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI), stratified by exacerbation history.Methods: COPD patients who initiated TIO/OLO or FF/UMEC/VI between 06/01/2015— 11/30/2019 (index date=first pharmacy fill-date with ≥ 30 consecutive treatment days) were identified from the Optum Research Database. Patients were ≥ 40 years old and continuously enrolled for 12 months during the baseline period and ≥ 30 days during follow-up. Patients were stratified into GOLD A/B (0– 1 baseline non-hospitalized exacerbation), No exacerbation (subset of GOLD A/B), and GOLD C/D (≥ 2 non-hospitalized and/or ≥ 1 hospitalized baseline exacerbation). Baseline characteristics were balanced with propensity score matching (1:1). Adjusted risks of exacerbation, pneumonia diagnosis, and COPD and/or pneumonia-related utilization and costs were evaluated.Results: Adjusted exacerbation risk was similar in GOLD A/B and No exacerbation subgroups, and lower in GOLD C/D for FF/UMEC/VI versus TIO/OLO initiators (hazard ratio: 0.87; 95% CI: 0.78, 0.98, p=0.020). Adjusted pneumonia risk was similar between cohorts across the GOLD subgroups. Adjusted COPD and/or pneumonia-related population annualized pharmacy costs were significantly higher for FF/UMEC/VI versus TIO/OLO initiators across subgroups, p< 0.001. Adjusted COPD and/or pneumonia-related population annualized total healthcare costs were significantly higher for FF/UMEC/VI versus TIO/OLO initiators in the GOLD A/B and No exacerbation, subgroups, p< 0.001 (cost ratio [95% CI]: 1.25 [1.13, 1.38] and 1.21 [1.09, 1.36], respectively), but similar in the GOLD C/D subgroup.Conclusion: These real-world results support ATS and GOLD recommendations for treating low-exacerbation risk COPD patients with dual bronchodilators and TT for more severe, higher-exacerbation risk COPD patients.Keywords: COPD, tiotropium bromide/olodaterol, fluticasone furoate/umeclidinium/vilanterol, exacerbation history, healthcare resource utilization, cost, clinical outcomes |
| first_indexed | 2024-04-09T17:04:19Z |
| format | Article |
| id | doaj.art-823bafb6b1a5487eb5b5a252215d4829 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-04-09T17:04:19Z |
| publishDate | 2023-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-823bafb6b1a5487eb5b5a252215d48292023-04-20T18:42:14ZengDove Medical PressInternational Journal of COPD1178-20052023-04-01Volume 1862564183156Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation HistorySethi SClark BBengtson LGBuysman EKPalli SSargent AShaikh AFerguson GTSanjay Sethi,1 Brendan Clark,2 Lindsay GS Bengtson,3 Erin K Buysman,3 Swetha Palli,2 Andrew Sargent,3 Asif Shaikh,2 Gary T Ferguson4 1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; 2Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 3Optum Life Sciences, Eden Prairie, MN, USA; 4Department of Medicine, Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USACorrespondence: Brendan Clark, Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Road, Ridgefield, CT, 06877, USA, Email brendan.clark@boehringer-ingelheim.comBackground: ATS and GOLD guidelines recommend treating low-exacerbation risk COPD patients with dual (LAMA/LABA) agents and reserving triple therapy (TT; LAMA/LABA and inhaled corticosteroids [ICS]) for severe cases with higher-exacerbation risk. However, TT often is prescribed across the COPD spectrum. This study compared COPD exacerbations, pneumonia diagnosis, healthcare resource utilization, and costs for patients initiating tiotropium bromide/olodaterol (TIO/OLO) and a TT, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI), stratified by exacerbation history.Methods: COPD patients who initiated TIO/OLO or FF/UMEC/VI between 06/01/2015— 11/30/2019 (index date=first pharmacy fill-date with ≥ 30 consecutive treatment days) were identified from the Optum Research Database. Patients were ≥ 40 years old and continuously enrolled for 12 months during the baseline period and ≥ 30 days during follow-up. Patients were stratified into GOLD A/B (0– 1 baseline non-hospitalized exacerbation), No exacerbation (subset of GOLD A/B), and GOLD C/D (≥ 2 non-hospitalized and/or ≥ 1 hospitalized baseline exacerbation). Baseline characteristics were balanced with propensity score matching (1:1). Adjusted risks of exacerbation, pneumonia diagnosis, and COPD and/or pneumonia-related utilization and costs were evaluated.Results: Adjusted exacerbation risk was similar in GOLD A/B and No exacerbation subgroups, and lower in GOLD C/D for FF/UMEC/VI versus TIO/OLO initiators (hazard ratio: 0.87; 95% CI: 0.78, 0.98, p=0.020). Adjusted pneumonia risk was similar between cohorts across the GOLD subgroups. Adjusted COPD and/or pneumonia-related population annualized pharmacy costs were significantly higher for FF/UMEC/VI versus TIO/OLO initiators across subgroups, p< 0.001. Adjusted COPD and/or pneumonia-related population annualized total healthcare costs were significantly higher for FF/UMEC/VI versus TIO/OLO initiators in the GOLD A/B and No exacerbation, subgroups, p< 0.001 (cost ratio [95% CI]: 1.25 [1.13, 1.38] and 1.21 [1.09, 1.36], respectively), but similar in the GOLD C/D subgroup.Conclusion: These real-world results support ATS and GOLD recommendations for treating low-exacerbation risk COPD patients with dual bronchodilators and TT for more severe, higher-exacerbation risk COPD patients.Keywords: COPD, tiotropium bromide/olodaterol, fluticasone furoate/umeclidinium/vilanterol, exacerbation history, healthcare resource utilization, cost, clinical outcomeshttps://www.dovepress.com/healthcare-resource-utilization-cost-and-clinical-outcomes-in-patients-peer-reviewed-fulltext-article-COPDcopdtiotropium bromide/olodaterolfluticasone furoate/umeclidinium/vilanterolexacerbation historyhealthcare resource utilizationcostclinical outcomes |
| spellingShingle | Sethi S Clark B Bengtson LG Buysman EK Palli S Sargent A Shaikh A Ferguson GT Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History International Journal of COPD copd tiotropium bromide/olodaterol fluticasone furoate/umeclidinium/vilanterol exacerbation history healthcare resource utilization cost clinical outcomes |
| title | Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History |
| title_full | Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History |
| title_fullStr | Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History |
| title_full_unstemmed | Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History |
| title_short | Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History |
| title_sort | healthcare resource utilization cost and clinical outcomes in patients diagnosed with copd initiating tiotropium bromide olodaterol versus fluticasone furoate umeclidinium vilanterol based on exacerbation history |
| topic | copd tiotropium bromide/olodaterol fluticasone furoate/umeclidinium/vilanterol exacerbation history healthcare resource utilization cost clinical outcomes |
| url | https://www.dovepress.com/healthcare-resource-utilization-cost-and-clinical-outcomes-in-patients-peer-reviewed-fulltext-article-COPD |
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