Healthcare Resource Utilization, Cost and Clinical Outcomes in Patients Diagnosed with COPD Initiating Tiotropium Bromide/Olodaterol versus Fluticasone Furoate/Umeclidinium/Vilanterol Based on Exacerbation History

Sanjay Sethi,1 Brendan Clark,2 Lindsay GS Bengtson,3 Erin K Buysman,3 Swetha Palli,2 Andrew Sargent,3 Asif Shaikh,2 Gary T Ferguson4 1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; 2Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 3Optum Life Sciences, Eden Prairie, MN, USA; 4Department of Medicine, Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USACorrespondence: Brendan Clark, Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Road, Ridgefield, CT, 06877, USA, Email [email protected]: ATS and GOLD guidelines recommend treating low-exacerbation risk COPD patients with dual (LAMA/LABA) agents and reserving triple therapy (TT; LAMA/LABA and inhaled corticosteroids [ICS]) for severe cases with higher-exacerbation risk. However, TT often is prescribed across the COPD spectrum. This study compared COPD exacerbations, pneumonia diagnosis, healthcare resource utilization, and costs for patients initiating tiotropium bromide/olodaterol (TIO/OLO) and a TT, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI), stratified by exacerbation history.Methods: COPD patients who initiated TIO/OLO or FF/UMEC/VI between 06/01/2015— 11/30/2019 (index date=first pharmacy fill-date with ≥ 30 consecutive treatment days) were identified from the Optum Research Database. Patients were ≥ 40 years old and continuously enrolled for 12 months during the baseline period and ≥ 30 days during follow-up. Patients were stratified into GOLD A/B (0– 1 baseline non-hospitalized exacerbation), No exacerbation (subset of GOLD A/B), and GOLD C/D (≥ 2 non-hospitalized and/or ≥ 1 hospitalized baseline exacerbation). Baseline characteristics were balanced with propensity score matching (1:1). Adjusted risks of exacerbation, pneumonia diagnosis, and COPD and/or pneumonia-related utilization and costs were evaluated.Results: Adjusted exacerbation risk was similar in GOLD A/B and No exacerbation subgroups, and lower in GOLD C/D for FF/UMEC/VI versus TIO/OLO initiators (hazard ratio: 0.87; 95% CI: 0.78, 0.98, p=0.020). Adjusted pneumonia risk was similar between cohorts across the GOLD subgroups. Adjusted COPD and/or pneumonia-related population annualized pharmacy costs were significantly higher for FF/UMEC/VI versus TIO/OLO initiators across subgroups, p< 0.001. Adjusted COPD and/or pneumonia-related population annualized total healthcare costs were significantly higher for FF/UMEC/VI versus TIO/OLO initiators in the GOLD A/B and No exacerbation, subgroups, p< 0.001 (cost ratio [95% CI]: 1.25 [1.13, 1.38] and 1.21 [1.09, 1.36], respectively), but similar in the GOLD C/D subgroup.Conclusion: These real-world results support ATS and GOLD recommendations for treating low-exacerbation risk COPD patients with dual bronchodilators and TT for more severe, higher-exacerbation risk COPD patients.Keywords: COPD, tiotropium bromide/olodaterol, fluticasone furoate/umeclidinium/vilanterol, exacerbation history, healthcare resource utilization, cost, clinical outcome

Three-generation households and child mental health in European countries

PURPOSE: To evaluate the associations between the presence of a grand parent at home that is three-generation household, with children mental health in diverse countries whether this situation is frequent or not. METHODS: Data from the School Children Mental Health in Europe cross-sectional survey in six countries (n = 4582) were used to examine the association between three-generation households and child mental health across Europe. The parent and teacher Strengths and Difficulties Questionnaire was combined to assess child mental clinical problems. RESULTS: Overall, 25.13% of European families live with at least one grandparent: 5.46% in Western and 29.70% in Eastern Europe. Controlling for key sociodemographic variables and for country of residence, the presence of a grandparent is associated with an increased risk for child mental health problems in the total sample (OR 1.37, p = 0.002). In two-parent homes, the effect of the presence of a grandparent is significant (OR 1.40, p = 0.026), while it is not in single-parent homes. In each country, the presence of a grandparent is a risk for either externalizing or internalizing problems. CONCLUSIONS: Programs may be developed to educate elderly people to better respect their children's role as parents so having a grandparent in the home can become an asset for family members rather than a burden