UMECLIDINIUM/VILANTEROL (UMEC/VI) COMPARED WITH TIOTROPIUM (TIO) FOR TIME-TO-FIRST INPATIENT ADMISSION AMONG PATIENTS WITH COPD IN A MANAGED CARE POPULATION

Abstract

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: UMEC/VI has been shown to significantly improve lung function in patients with COPD compared to monotherapy (LAMA or LABA), and UMEC/VI has been associated with lower lifetime medical costs and better cost‑effectiveness than TIO. However, limited evidence is available on the impact of these therapies on hospitalizations, which is the largest medical cost driver for COPD. This study examined the time-to-first and rate of COPD-related inpatient admissions among patients with COPD who initiated maintenance therapy with UMEC/VI versus TIO. METHODS: This retrospective matched cohort analysis of the Optum Clinformatics Data Mart database identified patients initiated on UMEC/VI or TIO between 01/01/2014–12/31/2018. The index date for both cohorts was defined as the first dispensing date. Inclusion criteria were: age ≥40 years at index, continuous enrollment for 12 months pre-index, and ≥1 diagnosis of COPD pre-index or on the index date. Patients with an asthma diagnosis or a dispensing for any ICS-, LABA-, or LAMA-containing controller pre-index were excluded. Propensity score matching was used to balance baseline characteristics between cohorts. Time-to-first COPD-related admission was assessed during the on-treatment post-index period with Kaplan-Meier survival analysis and risk of admission was compared using hazard ratios (HRs) from Cox regression models. Rates of admissions were compared using rate ratios (RRs) from Poisson regression models; confidence intervals (CIs) and p-values were calculated using bootstrap procedures. RESULTS: Among patients who met the study criteria, matched UMEC/VI and TIO cohorts each included 7,997 patients with well-balanced characteristics. In both cohorts the mean age was 71 years and 47% were female; the most common pre-index comorbidities were chronic pulmonary disease (89–90%), hypertension (76%), diabetes (31%), peripheral vascular disorders (31%), and cardiac arrhythmias (30%). COPD-related admissions were significantly delayed and reduced in the UMEC/VI cohort. At 12 months post-index, 24.1% of UMEC/VI users had a COPD-related admission compared to 26.1% of TIO users, corresponding to a 13% lower risk of admission (HR [95% CI]: 0.87 [0.79–0.96]; p=0.006). UMEC/VI users also experienced 20% fewer COPD-related admissions compared to TIO users (RR [95% CI]: 0.80 [0.72–0.92]; p=0.008) over 12 months post-index. CONCLUSIONS: Patients with COPD initiating maintenance therapy with UMEC/VI had significantly lower risk of COPD-related inpatient admission while on treatment compared with those initiating maintenance therapy with TIO. Corresponding rates of COPD-related admissions were also significantly lower for patients treated with UMEC/VI versus TIO. CLINICAL IMPLICATIONS: UMEC/VI as initial maintenance therapy in patients with COPD may reduce and delay hospitalizations. DISCLOSURES: No relevant relationships Added 05/27/2020 by Mei Sheng Duh, source=Web Response, value=Grant/Research Support Removed 05/27/2020 by Mei Sheng Duh, source=Web Response Consultant relationship with GlaxoSmithKline Please note: >$100000 Added 05/01/2020 by Guillaume Germain, source=Web Response, value=Grant/Research Support Employee relationship with GlaxoSmithKline Please note: >$100000 Added 03/16/2020 by Beth Hahn, source=Web Response, value=Ownership interest I am an employee of Analysis Group relationship with GSK Please note: >$100000 Added 05/28/2020 by François Laliberté, source=Web Response, value=Grant/Research Support Consultant relationship with GSK Please note: >$100000 Added 05/22/2020 by Sean MacKnight, source=Web Response, value=Consulting fee No relevant relationships by Chad Moretz, source=Web Response Employee relationship with GlaxoSmithKline Please note: >$100000 Added 05/28/2020 by Riju Ray, source=Web Response, value=Salary Employee relationship with GSK Please note: >$100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Salary My spouse/partner as a Employee relationship with GSK Please note: >$100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Salary Hold stocks relationship with GSK Please note: $20001 - $100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Stocks My spouse/partner as a Hold stocks relationship with GSK Please note: $20001 - $100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Stocks Employee relationship with GSK Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Salary Former Employee relationship with Astra Zeneca Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Stock Employee relationship with GSK Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Stock Former Employee relationship with Teva Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Stock