Abstract
BackgroundTo assess the symptomatic and cost burden among patients initiating long-acting bronchodilator (LABD) therapy and impact of adherence on healthcare resource use and costs.MethodsThis retrospective cohort study identified patients with COPD who were newly prescribed a LABD (long-acting muscarinic antagonist [LAMA], long-acting beta2-agonist [LABA], a combination of LABA+LAMA or combination of LABA with inhaled corticosteroid [ICS]/LABA) between January 1, 2009 and November 30, 2013 from the UK Clinical Practice Research Datalink. Health care resource use, costs and symptom burden up to 24 months after treatment initiation were estimated. Adherence in the follow-up period was assessed using the medication possession ratio (MPR ≥80 %).ResultsThe cohort comprised 8283 LABD initiators (16 % LABA, 81 % LAMA and 3 % LABA+LAMA) and 9246 LABA+ICS initiators with generally similar baseline characteristics; prior exacerbation rate was higher in the LABA+ICS cohort. Less than half the patients (LAMA:42 %; LABA:34 % and LABA+ICS:34 %) were adherent to their index medication. Among adherent patients, the total annual per patient cost of COPD was £3008 for LAMA initiators, £2783 for LABA initiators and £3376 for LABA+ICS initiators; primarily due to general practitioner interactions. Among patients with a Medical Research Council dyspnea score recorded during 24 months follow-up, a substantial proportion of adherent patients (LAMA: 41 %; LABA: 45 %; LABA+ICS 44 %) had clinically significant dyspnoea (MRC ≥ 3).ConclusionCost and symptomatic burden of COPD was high among patients initiating maintenance treatment, including patients adherent with their initial treatment. General practitioner interactions were the primary driver of costs. Further, real world studies are required to address unmet needs and optimize treatment pathways to improve COPD symptom burden and outcomes.
Highlights
To assess the symptomatic and cost burden among patients initiating long-acting bronchodilator (LABD) therapy and impact of adherence on healthcare resource use and costs
For patients whose first prescription was Long-acting muscarinic antagonist (LAMA) or Long-acting beta2-agonist (LABA), the patient record was searched for other Chronic obstructive pulmonary disease (COPD) medications (LABD from a different class or inhaled corticosteroids (ICS)) which overlapped with the index LAMA or LABA by at least one day, and these were labelled as dual therapy of LABA+LAMA or LABA+ICS
86 % had been diagnosed with COPD prior to initiating their LABD treatment whilst the remaining were diagnosed within 12 months after index prescription
Summary
To assess the symptomatic and cost burden among patients initiating long-acting bronchodilator (LABD) therapy and impact of adherence on healthcare resource use and costs. Inhaled long-acting bronchodilators (LABDs) with or without inhaled corticosteroids (ICS) are the mainstay of COPD therapy when symptoms persist, despite the use of short-acting bronchodilators (SABDs) [1, 2]. Punekar et al Respiratory Research (2015) 16:141 value, LABA+ICS or LAMA for those with FEV1 < 50 % of the predicted value, and in those with higher risk for exacerbations and persistent symptoms open triple therapy (LABA+ICS+LAMA) [2]. These recommendations are broadly in line with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy [1]. Comparative effectiveness studies suggest that there is potential for modest differences in efficacy between the inhaled LABD classes, but each has shown potential to improve lung function, improve quality of life and reduce exacerbations [3]
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