SESSION TITLE: COPD Treatment
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM
PURPOSE: GOLD guidelines recommend use of long-acting muscarinic antagonist (LAMA) monotherapy as an early treatment option for patients with COPD. However, some patients initiate free combination therapy of LAMA and long-acting beta agonist (LABA) while still in the early stages of COPD. This study aims to identify treatment outcomes and costs associated with LAMA+LABA use in patients with predominantly low to moderate complexity COPD, as defined by a claims based algorithm.
METHODS: Patients initiating LAMA alone or LAMA+LABA were identified in the MarketScan database (1/1/09-3/31/12). Included patients were >40 years, had medical and pharmacy claims data for 12 months before and after index date, had ≥1 claim for COPD (ICD-9 491, 492, 496), no claims for asthma, non-specified bronchitis, respiratory cancer or cystic fibrosis ≤1 year, and no LABA or LAMA use ≤1 year. Patients taking LAMA+LABA were identified first due to limited sample size. LAMA patients were randomly selected using the same criteria in a 5:1 ratio. Demographic and clinical characteristics were compared between groups using chi-square and t-tests. Logistic regression models were used to adjust for baseline variability and assess differences in the likelihood of utilization between groups. Multivariate generalized linear regression models were used to compare all-cause and COPD-related healthcare costs.
RESULTS: Inclusion criteria identified 274 LAMA+LABA patients; 1,370 LAMA monotherapy patients were then randomly selected. Patients in both groups were similar in terms of age, geographic region, and disease complexity, while patients on LAMA+LABA had more comorbidities. Adjusting for observed differences in baseline characteristics, LAMA+LABA patients had greater all-cause healthcare resource utilization and associated costs; however, only drug costs were significantly different, with higher costs for patients on LAMA+LABA compared with patients on LAMA alone ($7,902 vs $5,808, p<0.0001). Results were similar for COPD-related healthcare resource utilization.
CONCLUSIONS: COPD patients taking LAMA+LABA therapy had similar healthcare resource utilization and costs when compared to patients taking LAMA alone, despite controlling for baseline characteristics like disease complexity and comorbidities.
CLINICAL IMPLICATIONS: The addition of LABA to LAMA therapy in low or moderate complexity COPD patients may result in higher drug costs with no significant reduction in all-cause and COPD-related healthcare resource utilization.
DISCLOSURE: Michelle Mocarski: Employee: Forest Research Institute Wenyi Wang: Consultant fee, speaker bureau, advisory committee, etc.: Forest Research Institute Shawn Sun: Employee: Forest Research Institute Mona Khalid: Consultant fee, speaker bureau, advisory committee, etc.: Forest Research Institute Ronald Aubert: Consultant fee, speaker bureau, advisory committee, etc.: Forest Research Institute Shailja Dixit: Employee: Forest Research Institute
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