PURPOSE: To examine risk of first COPD-related exacerbation and related healthcare costs in patients with chronic bronchitis (CB).
METHODS: Retrospective observational study using large US health-insurance claims data (7/97–1/05) to identify patients with diagnoses of CB (ICD-9-CM 491.xx) who received new prescription(s) for therapy with fluticasone propionale/salmeterol combination 250/50mg (FSC), inhaled corticosteroids (ICS), salmeterol (SAL), ipratropium (IPR), or ipratropium/albuterol combination (IAC) (“index date”). Patients with < 12 months of continuous eligibility before or after index date were excluded. Date of the earliest claim for any study drug was designated as the “index date”; the one year period prior to the index date as the “pre-index” period; the period beginning with the index date and ending with the last date of eligibility as the “follow-up” period. Time to first COPD-related hospitalization (IP) or emergency department (ED) visit during follow-up was examined using Cox proportional hazards regression. COPD-related costs during the first 12-months follow-up were analyzed using generalized linear model regression. Outcomes were evaluated using variable length follow-up while costs were analyzed using fixed length follow-up approach.
RESULTS: Receipt of FSC (n=1361) was associated with 48% lower risk of COPD-related IP (p=0.001) and 41% lower risk of COPD-related IP or ED visit compared to IPR (n=1316) (p=0.001). Excluding patients with asthma, FSC (n=792) was associated with 47% lower risk of first COPD-related hospitalization (p=0.015) and 43% lower risk of first COPD-related IP or ED visit compared to IPR (n=1002) (p=0.003). FSC was associated with significantly lower costs of IP/ED visit (-$507) but higher adjusted pharmacy costs (+$261) vs. IPR with lower total costs (not statistically significant). Compliance measured by medication possession ratio was 12% greater with FSC compared to IPR (p<0.05). Comparisons of FSC with IAC were generally similar.
CONCLUSION: In patients with chronic bronchitis, initial maintenance therapy with FSC 250/50 results in improved outcomes versus ipratropium-based therapy with relatively modest increase in costs of total COPD-related care.
CLINICAL IMPLICATIONS: Treatment with ICS+LABA combination is associated with better outcomes for CB patients.
DISCLOSURE: Anand Dalal, Employee Anand Dalal is currently employed by GlaxoSmithKline (GSK); Consultant fee, speaker bureau, advisory committee, etc. Tom Delea was a consultant who received funding from GSK to complete this analysis. Analysis was done independently and without any direction from GSK. CB Blanchette was also a consultant at LRRI.; No Product/Research Disclosure Information