Abstract
BackgroundThis retrospective cohort study compared the risks of exacerbations and COPD-related healthcare costs between patients with chronic obstructive pulmonary disease (COPD) initiating tiotropium (TIO) alone and patients initiating triple therapy with fluticasone-salmeterol combination (FSC) added to TIO.MethodsManaged-care enrollees who had an index event of ≥ 1 pharmacy claim for TIO during the study period (January 1, 2003-April 30, 2008) and met other eligibility criteria were categorized into one of two cohorts depending on their medication use. Patients in the TIO+FSC cohort had combination therapy with TIO and FSC, defined as having an FSC claim on the same date as the TIO claim. Patients in the TIO cohort had no such FSC use. The risks of COPD exacerbations and healthcare costs were compared between cohorts during 1 year of follow-up.ResultsThe sample comprised 3333 patients (n = 852 TIO+FSC cohort, n = 2481 TIO cohort). Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation (hazard ratio 0.772; 95% confidence interval [CI] 0.641, 0.930) and any exacerbation (hazard ratio 0.763; 95% CI 0.646, 0.949) and a nonsignificant reduction in COPD-related adjusted monthly medical costs.ConclusionsTriple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation and any exacerbation over a follow-up period of up to 1 year. These improvements were gained with triple therapy at roughly equal cost of that of TIO alone.
Highlights
This retrospective cohort study compared the risks of exacerbations and COPD-related healthcare costs between patients with chronic obstructive pulmonary disease (COPD) initiating tiotropium (TIO) alone and patients initiating triple therapy with fluticasone-salmeterol combination (FSC) added to TIO
The study reported was conducted to compare the risks of COPD exacerbations and COPD-related healthcare costs between patients initiating TIO alone and patients initiating triple therapy with FSC added to TIO
We found that 24.1% of the total number of TIO users had long-acting beta-agonist (LABA)/inhaled corticosteroids (ICS) before their first-ever TIO prescription before any study criteria were applied
Summary
This retrospective cohort study compared the risks of exacerbations and COPD-related healthcare costs between patients with chronic obstructive pulmonary disease (COPD) initiating tiotropium (TIO) alone and patients initiating triple therapy with fluticasone-salmeterol combination (FSC) added to TIO. Triple therapy, which adds an anticholinergic to ICS/LABA combinations, has been associated with greater improvements in lung function and quality of life and reduced rates of hospitalization compared with anticholinergic therapy alone [12,13,14,15,16,17]. In a randomized, doubleblind, placebo-controlled study of 449 patients with moderate or severe COPD, addition of FSC to TIO improved lung function and quality of life and reduced hospitalization rates, it did not significantly reduce the rates of healthcare utilization-defined COPD exacerbations over a 1-year period [12].
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