Chronic Obstructive Pulmonary Disease Maintenance Medication Research Articles

Healthcare utilization and costs among chronic bronchitis patients treated with maintenance medications from a US managed care population

Objectives:This study aimed to examine the real-world healthcare resource utilization (HCRU) and direct costs among chronic bronchitis (CB) patients treated with chronic obstructive pulmonary disease (COPD) maintenance medications.Methods:This retrospective analysis utilized administrative claims data from 14 US commercial managed care plans. Eligible patients were ≥40 years old, had ≥2 years of continuous enrollment, ≥1 CB (ICD-9-CM code 491.xx) hospitalization or emergency department (ED) visit or ≥2 office visits between 1/1/2004 and 5/31/2011, and had ≥2 pharmacy fills for COPD medications during follow-up (first fill served as the index date). All-cause and COPD-related HCRU and costs were assessed during follow-up. Multivariate models were utilized to identify predictors of total costs.Results:Treated CB patients (n = 17,382; 50.6% female; mean age 66.7 (SD = 11.4) years) had a mean of 7.6 (SD = 6.3) COPD maintenance medication fills during follow-up. Overall, 32.6% of patients had ≥1 COPD-related inpatient hospitalizations, 12.9% had ≥1 ED visit, and 81.8% had ≥1 office visit. Mean all-cause and COPD-related total costs were $25,747 (SD = $51,105) and $12,609 (SD = $36,801), respectively, during follow-up. Among the sub-group with ≥1 exacerbation during baseline year, 42.3% had ≥1 COPD-related inpatient hospitalization, 18.5% had ≥1 ED visit, and 88.2% had ≥1 office visit. Mean follow-up all-cause and COPD-related total costs were $29,861 (SD = $49,799) and $16,784 (SD = $34,170), respectively. The number of baseline exacerbations was a significant predictor of all-cause and COPD-related total costs during follow-up.Limitations:This study lacked standard measures of CB severity; however, severity proxies were utilized.Conclusion:HCRU and costs among CB patients were substantial during follow-up, despite treatment with COPD maintenance medications. Additional interventions aiming to prevent or reduce HCRU and costs among CB patients warrant exploration.

Should Medicare rely on high drug spending as a criterion for medication therapy management programmes?

Abstract Objectives The goal of Medicare Part D medication therapy management programmes (MTMPs) is to optimize medication use by beneficiaries. The Centers for Medicare & Medicaid Services require prescription drug plans (PDPs) to consider numbers of chronic medications and conditions, and total Part D spending when targeting beneficiaries for MTMPs. However, there is no explicit evidence base establishing these criteria. The objectives were to examine the associations of Part D spending with medication use and adherence among Medicare beneficiaries with chronic obstructive pulmonary disease (COPD). Methods This retrospective cross-sectional study used a 5% random sample of Medicare beneficiaries with COPD enrolled in stand-alone PDPs and Medicare Parts A and B in 2006–2007 (n = 72 912). Maintenance medication use and adherence for COPD were measured in three domains: discontinuation, duration of therapy and proportion of days covered. Key findings Proportions of beneficiaries using COPD maintenance medications increased with Part D spending, from 33.4% (quintile 1) to 60.5% (quintile 5), after covariant adjustment. Among maintenance medication users, the adjusted proportions of beneficiaries exhibiting better adherence also increased with spending, with the top 20% of spenders having the highest proportion of beneficiaries exhibiting good adherence. Adjusted proportions of beneficiaries discontinuing medications decreased with increased Part D spending. Conclusions The Part D MTMP spending criterion (US$4000 in 2007; US$3000 in 2010) may be an inappropriate target for identifying Medicare beneficiaries in need of adherence counselling. Findings suggest higher spenders may have learned healthy adherence behaviours, whereas lower spenders may be prone to discontinue medication and/or demonstrate poor adherence behaviours.

Association of Chronic Obstructive Pulmonary Disease Maintenance Medication Adherence With All-Cause Hospitalization and Spending in a Medicare Population

BackgroundAlthough maintenance medications are a cornerstone of chronic obstructive pulmonary disease (COPD) management, adherence remains suboptimal. Poor medication adherence is implicated in poor outcomes with other chronic conditions; however, little is understood regarding links between adherence and outcomes in COPD patients. ObjectiveThis study investigates the association of COPD maintenance medication adherence with hospitalization and health care spending. MethodsUsing the 2006 to 2007 Chronic Condition Warehouse administrative data, this retrospective cross-sectional study included 33,816 Medicare beneficiaries diagnosed with COPD who received at least 2 prescriptions for ≥1 COPD maintenance medications. After a 6-month baseline period (January 1, 2006 to June 30, 2006), beneficiaries were followed through to December 31, 2007 or death. Two medication adherence measures were assessed: medication continuity and proportion of days covered (PDC). PDC values ranged from 0 to 1 and were calculated as the number of days with any COPD maintenance medication divided by duration of therapy with these agents. The association of adherence with all-cause hospital events and Medicare spending were estimated using negative binomial and γ generalized linear models, respectively, adjusting for sociodemographics, Social Security disability insurance status, low-income subsidy status, comorbidities, and proxy measures of disease severity. ResultsImproved adherence using both measures was significantly associated with reduced rate of all-cause hospitalization and lower Medicare spending. Patients who continued with their medications had lower hospitalization rates (relative rate [RR] = 0.88) and lower Medicare spending (–$3764), compared with patients who discontinued medications. Similarly, patients with PDC ≥0.80 exhibited lower hospitalization rates (RR = 0.90) and decreased spending (–$2185), compared with patients with PDC <0.80. ConclusionsCOPD patients with higher adherence to prescribed regimens experienced fewer hospitalizations and lower Medicare costs than those who exhibited lower adherence behaviors. Findings suggested the clinical and economic importance of medication adherence in the management of COPD patients in the Medicare population.

Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population.

BackgroundExacerbations of chronic obstructive pulmonary disease (COPD) lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients.MethodsFor this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40–89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx), and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics.ResultsThe final study sample involved 8554 patients; mean age was 70.1 ± 8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars) for the overall population and $6381 for patients with two or more exacerbations. All-cause health care costs were $18,976 for the overall population and $23,901 for patients with history of two or more exacerbations. Severity of exacerbations, presence of cardiovascular disease, diabetes, and long-term oxygen use were associated with higher adjusted costs.ConclusionsThe results indicate that despite treatment with maintenance medications, COPD patients continue to have exacerbations resulting in higher costs. New medications and disease management interventions are warranted to reduce the severity and frequency of exacerbations and the related cost impact of the disease.

Impact of maintenance therapy on hospitalization and expenditures for medicare beneficiaries with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is associated with high levels of hospitalization and health care expenditures among the aged. Adherence to appropriate maintenance drug regimens has been reported to reduce hospitalization and health care spending in clinical trials. However, little research has been conducted to compare use versus nonuse of these medications in terms of health-related outcomes in routine practice. Objective: The purpose of this study was to compare differences between users and nonusers of maintenance medications in terms of selected outcomes for a nationally representative sample of Medicare beneficiaries with COPD. Methods: The study sample was selected from Medicare Current Beneficiary Surveys conducted between 1997 and 2005. Beneficiaries with COPD who used ≥1 maintenance medication annually were compared with nonusers on 3 claims-based outcomes: any hospitalization, any rehospitalization within 31 days, and total annual Medicare expenditures. Results: The study sample consisted of 6322 Medicare beneficiaries who contributed a total of 9161 person-year observations for analysis. Over the 9-year study period, 39.9% (3659/9161) of the person-year observations were recorded for maintenance medication users, and 60.1% (5502/9161) were recorded for nonusers. Most of the observations for medication users involved beneficiaries who were female (50.1% [1833/3659]), non-Hispanic white (85.4% [3124/3659]), and ≥65 years of age (88.2% [3228/3659]); most of the observations for nonusers involved beneficiaries who were male (51.9% [2855/5502]), non-Hispanic white (82.7% [4550/5502]), and ≥65 years of age (88.1% [4848/5502]). Annually, 40% of the sample filled prescriptions for COPD maintenance medications. In multivariate models, maintenance drug users were less likely than nonusers to be hospitalized (odds ratio [OR] = 0.70; 95% CI, 0.61 to 0.79) or rehospitalized (OR= 0.74; 95% CI, 0.63 to 0.87), and had significantly lower annual Medicare expenditures (−$3916; 95% CI, −$4977 to −$2854). Conclusions: In this comparison of users and nonusers of maintenance medication for COPD, use of maintenance therapy was associated with significantly lower risks of hospitalization and rehospitalization and reduced Medicare expenditures.

COPD Management in Primary Care: An Observational, Community Pharmacy–Based Study

Chronic obstructive pulmonary disease (COPD) is a prevalent disease that is frequently treated in primary care. However, data regarding the primary care management of COPD are scarce. Such observational data are necessary to detect problem areas and to develop targeted interventions for improvement of COPD management. To provide a detailed description of (1) drug therapy, (2) drug adherence, (3) inhalation technique, and (4) health status of patients with COPD recruited via community pharmacies. A cross-sectional, observational study was conducted in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire collecting information on personal characteristics, smoking history, influenza vaccination, COPD medication, and adverse effects. Adherence to COPD maintenance medication was analyzed 1 year retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Health status was evaluated with the St. George's Respiratory Questionnaire, the Clinical COPD Questionnaire, and the Modified Medical Research Council dyspnea scale. The mean age of the patients was 68.6 years; 73.7% were men and 37.2% were current smokers. The influenza vaccination status was significantly lower in patients aged less than 65 years (65.7%) than in patients aged 65 years or more (86.2%) (p < 0.001). Fixed combinations of inhaled corticosteroids and long-acting beta(2)-agonists were the most frequently used COPD medications (75.4%). About 48% of patients were underadherent (<80% adherence), 47% were adherent (80-120% adherence) and 5% were overadherent (>120% adherence). Predictors for underadherence were age and number of drugs. Twenty-one percent of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered-dose inhalers (pMDIs). This observational study on COPD management in primary care highlights 4 main aspects that could be improved: (1) drug adherence, (2) inhalation technique with pMDIs, (3) influenza vaccination in COPD patients younger than 65 years, and (4) smoking cessation.