ANNUAL EXPENDITURES AMONG PATIENTS WITH COPD INITIATING TIOTROPIUM/OLODATEROL VS TRIPLE THERAPY

Abstract

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: In 2018, 16.4 million U.S. adults reported a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) with annual healthcare costs projected to reach $49 billion by 2020. Up to 70% of COPD-related healthcare expenditures are attributable to acute COPD exacerbations. The 2018 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends long-acting muscarinic antagonists/beta2-agonists (LAMA+LABA) as next-in-line therapy for symptomatic COPD patients on mono-maintenance therapy. The addition of inhaled corticosteroids and escalation to Triple Therapy [TT] should be reserved for those experiencing further exacerbations and after risk/benefit (e.g., pneumonia) assessment. However, evidence reveals TT is over-prescribed in discordance with GOLD recommendations. The purpose of this study is to compare COPD-related plan paid costs among matched cohorts of TIO+OLO (a fixed-dose LAMA+LABA inhaler) vs. TT initiators in a U.S. Medicare Advantage population: a) naïve to maintenance treatment and b) stratified by baseline exacerbation history (proxy for COPD severity): no=0 exacerbation; single=1 moderate exacerbation; multiple/severe=≥2 moderate or ≥1 severe exacerbation(s). METHODS: This retrospective, observational post-hoc analysis included COPD patients aged ≥40 years initiating TIO+OLO or TT from 01 Jan 2014 to 31 Mar 2018 (treatment initiation date = index date). 12 months pre-index and ≥30 days post-index continuous medical/pharmacy coverage was required. Cohorts were propensity score matched 1:1. Multivariable analyses were used to estimate adjusted annualized post-index mean costs after matching. RESULTS: Among patients naïve to maintenance treatment, TIO+OLO patients had lower mean COPD-related total ($9,422 vs. $16,753; p<0.001), medical ($5,845 vs. 10,009; p<0.001) and pharmacy ($3,669 vs. $7,084; p<0.001) costs. TIO+OLO patients with no exacerbations had significantly lower mean COPD-related total costs ($7,342 vs $16,005; p<0.001) than patients who initiated TT, with lower medical ($3,675 vs. $9,199; p<0.001), and pharmacy ($3,685 vs. $7,032; p<0.001) costs. Among patients in the 'single' exacerbation group, TIO+OLO patients also had lower mean COPD-related total ($8,398 vs. $15,058; p<0.001), medical ($4,954 vs. $8,422; p<0.02) and pharmacy ($3,545 vs. $6,912; p<0.001) costs than TT patients. Among patients in the 'multiple/severe' group, TIO+OLO patients had lower mean COPD-related pharmacy costs ($3,761 vs. $7,249; p<0.001) but no significant difference in total costs ($17,262 vs. 22,979; p=0.1). CONCLUSIONS: Patients initiating TIO+OLO who were either naïve to maintenance treatment, and/or had no or single exacerbations prior to initiation had significantly lower medical and pharmacy costs versus those initiating TT. CLINICAL IMPLICATIONS: This real-world cost analysis illustrates the financial impact of prescribing TT, inconsistent with GOLD recommendations. DISCLOSURES: Employee relationship with Optum Please note: 09/2014 to present Added 05/04/2021 by Amy Anderson, source=Web Response, value=Salary Optum research sponsor relationship with Boehringer Ingelheim Please note: 2017 to current Added 05/04/2021 by Amy Anderson, source=Web Response, value=Research funding to Optum Employee relationship with Optum Please note: 11/2006 to current Added 04/26/2021 by Ami Buikema, source=Web Response, value=Salary Optum research sponsor relationship with Boehringer Ingelheim Please note: 2017 to current Added 04/26/2021 by Ami Buikema, source=Web Response, value=Research funding to Optum Employee relationship with Boehringer Ingelheim Corporation Please note: 2015-2021 Added 04/26/2021 by jess franchino-elder, source=Web Response, value=Salary No relevant relationships by Monica Frazer, source=Web Response no disclosure on file for Lisa Le;Employee relationship with Boehringer Ingelheim Pharmaceuticals, Inc. Please note: 08/07/17 to current Added 04/26/2021 by Swetha Palli, source=Web Response, value=Salary Employee relationship with Boehringer Ingelheim Pharmaceuticals, Inc. Please note: Aug 2017 - Current Added 04/26/2021 by Swetha Palli, source=Web Response, value=Salary