Decisions among these medication classes are stratified by severity of symptoms and exacerbation frequency and severity, instead of spirometric category (level of forced expiratory volume in 1 second ).Ī retrospective administrative claims study conducted by Dalal and colleagues 4 reported that the frequency of exacerbations in the first year of the study (2008) predicted the frequency and intensity of exacerbations in the subsequent 2-year period. 3įor the treatment of moderate or severe COPD, the Global initiative for chronic Obstructive Lung Disease (GOLD) 2 recommends either monotherapy (MT) with a long-acting muscarinic antagonist (LAMA) or a long-acting beta2-agonist (LABA), or combination therapy with a LAMA/LABA, inhaled corticosteroid (ICS)/LABA, or ICS/LAMA/LABA. 2 The total medical costs associated with COPD in 2010 in the United States were estimated at $32.1 billion, with costs due to work absenteeism accounting for an additional $3.9 billion. 1 Patients with COPD typically experience persistent respiratory symptoms and airflow obstruction. Online Supplemental Material: Read Online Supplemental Material (125KB) IntroductionĬhronic obstructive pulmonary disease (COPD) ranks fourth after cancer, heart disease, and unintentional injuries as a leading cause of death in the United States. A retrospective claims analysis of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in patients with chronic obstructive pulmonary disease. Running Head: Dual vs Monotherapy Bronchodilator: A Claims Studyįunding Support: This study was funded by AstraZeneca Pharmaceuticals LP (Wilmington, Delaware)Ībbreviations: chronic obstructive pulmonary disease, COPD monotherapy, MT long-acting muscarinic antagonist, LAMA long-acting beta2-agonist, LABA dual therapy, DT fixed-dose combination, FDC propensity score matching, PSM per patient per month, PPPM Global initiative for chronic Obstructive Lung Disease, GOLD inhaled corticosteroid, ICS Medicare Advantage with Part D, MAPD International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM emergency department, ED medication possession ratio, MPR proportion of days covered, PDC short-acting muscarinic antagonist, SAMA short-acting beta2-agonist, SABA Agency for Healthcare Research and Quality, AHRQ incidence rate ratio, IRR standard deviation, SDĬitation: Strange C, Walker V, Tong J, et al. Rates of discontinuation were similar.Ĭonclusions: Patients in the DT cohort had lower rates of exacerbations leading to hospitalization, lower COPD-related pharmacy and total costs PPPM, and lower rates of switching and augmentation compared to patients in the MT cohort. Patients in the DT cohort had lower rates of switching ( p<0.001) and augmentation ( p<0.001), and higher rates of non-persistence ( p<0.001) versus the MT cohort. This occurred despite lower mean COPD-related pharmacy fills PPPM in the DT versus MT cohorts (1.41 versus 1.51, respectively p=0.038). Patients in the DT versus MT cohort had lower rates of exacerbations leading to hospitalization (incidence rate ratio 0.7886 p=0.019), lower mean COPD-related pharmacy costs per patient per month (PPPM) ($300 versus $379, respectively p<0.001) and total costs PPPM ($990 versus $1203, respectively p=0.003). Patients were followed for approximately 1 year. Results: Following propensity score matching (PSM), 1286 patients remained in each cohort for analysis. Cohorts were propensity score matched 1:1 using baseline measures (e.g., exacerbations, hospitalizations) as proxies for COPD severity to create balanced cohorts. Patients diagnosed with cystic fibrosis, idiopathic pulmonary fibrosis, or asthma were excluded. Methods: COPD patients aged ≥ 40 years initiating monotherapy (MT) with either a long-acting muscarinic antagonist (LAMA) or long-acting beta2-agonist (LABA) or dual therapy (DT) with a LAMA/LABA fixed dose combination (FDC) between Januand Decemwere identified from a large U.S. Real world evidence for the benefits of combination therapy compared to monotherapy is lacking. Introduction: Patients with chronic obstructive pulmonary disease (COPD) increasingly receive combination bronchodilator therapies.
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