PRS44 CHARACTERISTICS OF MEDICARE ADVANTAGE BENEFICIARIES INITIATING LONG-ACTING MUSCARINIC ANTAGONISTS (LAMA) USING DRY POWDER OR SOFT MIST INHALERS

Abstract

Long acting muscarinic antagonists (LAMA) for chronic obstructive pulmonary disease (COPD) are available as dry powder inhalers (DPI) and soft mist inhalers (SMI). SMIs may deliver medication to the lungs more effectively especially among those with compromised inspiratory flow. To understand prescribing patterns for these devices, this study examined pre-treatment characteristics between patients initiating LAMA SMIs versus LAMA DPIs. Medicare Advantage beneficiaries with COPD newly initiating LAMA 01SEP2014-30JUN2018 (index date) were identified from the Optum Research Database, a large US administrative claims database. Patients were aged ≥40 years, with continuous enrollment 1 year pre- and ≥30 days post-index. Provider type was captured hierarchically from 1) index prescription and 2) most recent medical encounter preceding or on the index date. Pre-index characteristics included comorbidities, COPD-related medication use, severe/moderate acute COPD-related healthcare resource utilization (COPD-HRU), and mean COPD-related direct healthcare costs. Characteristics were compared between DPI and SMI cohorts using standardized differences (StdDiff). The study included 28,240 patients: 22,880 initiating LAMA DPI; 5,360 initiating LAMA SMI. Many characteristics were similar (StdDiff <10) between cohorts, including mean age (73), gender distribution (52% female), and comorbidities (mean Charlson Comorbidity Index 2.6). Key differences (StdDiff ≥10) included provider type; geography; COPD-HRU; use of short-acting beta-agonists, inhaled corticosteroid/long-acting beta agonist combination therapy, oral corticosteroids, and antibiotics. Differences in the SMI cohort vs the DPI cohort included a larger proportion of patients with a pulmonologist provider type (38% vs. 19%); ambulatory (i.e., office and outpatient) COPD-HRU (92% vs. 87%); lower inpatient COPD-HRU (28% vs. 37%), and COPD-related costs ($8,846 vs. $11,756), respectively. Patients treated with LAMA DPIs vs SMIs had similar pre-treatment characteristics, with most observed differences related to factors impacted by provider practice, suggesting use of LAMA SMIs may be correlated with patient management patterns.