PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation
Joseph Tkacz,1 Kristin A Evans,1 Daniel R Touchette,2 Edward Portillo,3 Charlie Strange,4 Anthony Staresinic,5 Norbert Feigler,5 Sushma Patel,5 Michael Pollack5 1Life Sciences, IBM Watson Health, Cambridge, MA, USA; 2Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illino...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2022-02-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/primus--prompt-initiation-of-maintenance-therapy-in-the-us-a-real-worl-peer-reviewed-fulltext-article-COPD |
| _version_ | 1818286642348163072 |
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| author | Tkacz J Evans KA Touchette DR Portillo E Strange C Staresinic A Feigler N Patel S Pollack M |
| author_facet | Tkacz J Evans KA Touchette DR Portillo E Strange C Staresinic A Feigler N Patel S Pollack M |
| author_sort | Tkacz J |
| collection | DOAJ |
| description | Joseph Tkacz,1 Kristin A Evans,1 Daniel R Touchette,2 Edward Portillo,3 Charlie Strange,4 Anthony Staresinic,5 Norbert Feigler,5 Sushma Patel,5 Michael Pollack5 1Life Sciences, IBM Watson Health, Cambridge, MA, USA; 2Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois College of Pharmacy, Chicago, IL, USA; 3Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA; 4Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA; 5BioPharmaceuticals, US Medical Affairs, AstraZeneca, Wilmington, DE, USACorrespondence: Michael Pollack, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA, Tel +1 302 377 4911, Email michael.pollack1@astrazeneca.comPurpose: Patients with chronic obstructive pulmonary disease (COPD) may experience moderate (requiring outpatient care) or severe (requiring hospitalization) disease exacerbations. Guidelines recommend escalation from dual to triple therapy (inhaled corticosteroid + long-acting beta agonist + long-acting muscarinic antagonist) after two moderate or one severe exacerbation in a year. This study examined whether prompt initiation of triple therapy lowers risk of future exacerbations and reduces healthcare costs, compared to delayed/very delayed triple therapy after an exacerbation.Patients and Methods: This retrospective observational study of US healthcare claims included patients ≥ 40 years old with COPD who initiated triple therapy (1/1/2011– 3/31/2020) after ≥ 2 moderate or ≥ 1 severe exacerbation in the prior year. The earliest of the second moderate or first severe exacerbation was the index date. Patients were stratified by triple therapy timing: prompt (≤ 30 days post-index), delayed (31– 180 days), very delayed (181– 365 days). COPD exacerbations, all-cause and COPD-related healthcare utilization and costs were assessed during 12 months post-index (follow-up). Multivariable regression estimated the effect of each 30-day delay in triple therapy on the odds of exacerbations, number of exacerbations, and costs during follow-up, controlling for patient characteristics.Results: A total of 24,770 patients were included: 7577 prompt, 9676 delayed, 7517 very delayed. Each 30-day delay of triple therapy was associated with 11% and 7% increases in the odds of any exacerbation and a severe exacerbation, respectively (odds ratio [95% CI]: 1.11 [1.10– 1.13] and 1.07 [1.05– 1.08]), a 4.3% (95% CI: 3.9– 4.6%) increase in the number of exacerbations, a 1.8% (95% CI: 1.3– 2.3%) increase in all-cause costs, and a 2.1% (95% CI: 1.6– 2.6%) increase in COPD-related costs during follow-up.Conclusion: Promptly initiating triple therapy after two moderate or one severe exacerbation is associated with decreased morbidity and economic burden in COPD. Proactive disease management may be warranted to prevent future exacerbations and lower costs among patients with COPD.Keywords: costs, discharge, hospitalization, utilization |
| first_indexed | 2024-12-13T01:27:50Z |
| format | Article |
| id | doaj.art-e9e1bd52a0844a6a8745a7e542aceabb |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-12-13T01:27:50Z |
| publishDate | 2022-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-e9e1bd52a0844a6a8745a7e542aceabb2022-12-22T00:04:06ZengDove Medical PressInternational Journal of COPD1178-20052022-02-01Volume 1732934272842PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD ExacerbationTkacz JEvans KATouchette DRPortillo EStrange CStaresinic AFeigler NPatel SPollack MJoseph Tkacz,1 Kristin A Evans,1 Daniel R Touchette,2 Edward Portillo,3 Charlie Strange,4 Anthony Staresinic,5 Norbert Feigler,5 Sushma Patel,5 Michael Pollack5 1Life Sciences, IBM Watson Health, Cambridge, MA, USA; 2Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois College of Pharmacy, Chicago, IL, USA; 3Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA; 4Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA; 5BioPharmaceuticals, US Medical Affairs, AstraZeneca, Wilmington, DE, USACorrespondence: Michael Pollack, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA, Tel +1 302 377 4911, Email michael.pollack1@astrazeneca.comPurpose: Patients with chronic obstructive pulmonary disease (COPD) may experience moderate (requiring outpatient care) or severe (requiring hospitalization) disease exacerbations. Guidelines recommend escalation from dual to triple therapy (inhaled corticosteroid + long-acting beta agonist + long-acting muscarinic antagonist) after two moderate or one severe exacerbation in a year. This study examined whether prompt initiation of triple therapy lowers risk of future exacerbations and reduces healthcare costs, compared to delayed/very delayed triple therapy after an exacerbation.Patients and Methods: This retrospective observational study of US healthcare claims included patients ≥ 40 years old with COPD who initiated triple therapy (1/1/2011– 3/31/2020) after ≥ 2 moderate or ≥ 1 severe exacerbation in the prior year. The earliest of the second moderate or first severe exacerbation was the index date. Patients were stratified by triple therapy timing: prompt (≤ 30 days post-index), delayed (31– 180 days), very delayed (181– 365 days). COPD exacerbations, all-cause and COPD-related healthcare utilization and costs were assessed during 12 months post-index (follow-up). Multivariable regression estimated the effect of each 30-day delay in triple therapy on the odds of exacerbations, number of exacerbations, and costs during follow-up, controlling for patient characteristics.Results: A total of 24,770 patients were included: 7577 prompt, 9676 delayed, 7517 very delayed. Each 30-day delay of triple therapy was associated with 11% and 7% increases in the odds of any exacerbation and a severe exacerbation, respectively (odds ratio [95% CI]: 1.11 [1.10– 1.13] and 1.07 [1.05– 1.08]), a 4.3% (95% CI: 3.9– 4.6%) increase in the number of exacerbations, a 1.8% (95% CI: 1.3– 2.3%) increase in all-cause costs, and a 2.1% (95% CI: 1.6– 2.6%) increase in COPD-related costs during follow-up.Conclusion: Promptly initiating triple therapy after two moderate or one severe exacerbation is associated with decreased morbidity and economic burden in COPD. Proactive disease management may be warranted to prevent future exacerbations and lower costs among patients with COPD.Keywords: costs, discharge, hospitalization, utilizationhttps://www.dovepress.com/primus--prompt-initiation-of-maintenance-therapy-in-the-us-a-real-worl-peer-reviewed-fulltext-article-COPDcostsdischargehospitalizationutilization |
| spellingShingle | Tkacz J Evans KA Touchette DR Portillo E Strange C Staresinic A Feigler N Patel S Pollack M PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation International Journal of COPD costs discharge hospitalization utilization |
| title | PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation |
| title_full | PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation |
| title_fullStr | PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation |
| title_full_unstemmed | PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation |
| title_short | PRIMUS – Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation |
| title_sort | primus ndash prompt initiation of maintenance therapy in the us a real world analysis of clinical and economic outcomes among patients initiating triple therapy following a copd exacerbation |
| topic | costs discharge hospitalization utilization |
| url | https://www.dovepress.com/primus--prompt-initiation-of-maintenance-therapy-in-the-us-a-real-worl-peer-reviewed-fulltext-article-COPD |
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