Comparison of resource use by COPD patients on inhaled therapies with long-acting bronchodilators: a database study

<p>Abstract</p> <p>Background</p> <p>The purpose of this analysis was to compare health care costs and utilization among COPD patients who had long-acting beta-2 agonist (LABA) OR long-acting muscarinic antagonist (LAMA); LABA AND LAMA; or LABA, LAMA, AND inhaled corticosteroid (ICS) prescription claims.</p> <p>Methods</p> <p>This was a 12 month pre-post, retrospective analysis using COPD patients in a national administrative insurance database. Propensity score and exact matching were used to match patients 1:1:1 between the LABA or LAMA (formoterol, salmeterol, or tiotropium), LABA and LAMA (tiotropium/formoterol or tiotropium/salmeterol), and LABA, LAMA and ICS (bronchodilators plus steroid) groups. Post-period comparisons were evaluated with analysis of covariance. Costs were evaluated from a commercial payer perspective.</p> <p>Results</p> <p>A total of 523 patients were matched using 29 pre-period variables (e.g., demographics, medication exposure). Post-match assessments indicated balance among the cohorts. COPD-related costs differed among groups (LABA or LAMA $2,051 SE = 91; LABA and LAMA$2,823 SE = 62; LABA, LAMA and ICS $3,546 SE = 89; all p < .0001) with the differences driven by study medication costs. However, non-study COPD medication costs were higher for the LABA or LAMA therapy group ($911 SE = 91) compared to the LABA and LAMA therapy group ($668 SE = 58; p = 0.0238) and non-study respiratory medications were approximately$100 greater for the LABA or LAMA therapy group relative to both LABA and LAMA (p = .0018) and LABA, LAMA, and ICS (p = .0071) therapy groups. While there was no observed difference in outpatient costs, there was a slightly higher number of outpatient visits per patient in the LABA and LAMA (25.5 SE = 0.9, p = 0.0070) relative to the LABA or LAMA therapy group (22.3 SE = 0.8) and higher utilization (89.7% of patients) with COPD visits in the LABA and LAMA therapy group relative to both the LABA or LAMA (73.8%; p < .0001) and LABA, LAMA and ICS therapy groups (85.3; p = 0.0305).</p> <p>Conclusions</p> <p>Significant cost differences driven mainly by pharmaceuticals were observed among LABA or LAMA, LABA and LAMA and LABA, LAMA and ICS therapies. A COPD-related cost offset was observed from single bronchodilator to two bronchodilators. Addition of an ICS with two bronchodilators resulted in higher treatment costs without reduction in other COPD-related costs compared with two bronchodilators.</p

Asthma patients prefer Respimat&amp;reg; Soft Mist&amp;trade; Inhaler to Turbuhaler&amp;reg;

Rick Hodder1, Pat Ray Reese2, Terra Slaton31Divisions of Pulmonary and Critical Care, University of Ottawa, Ottawa, Ontario, Canada; 2Reese Associates Consulting LLC, Cary, North Carolina, USA; 3Consultant, West Columbia, South Carolina, USAAbstract: Device satisfaction and preference are important patient-reported outcomes to consider when choosing inhaled therapy. A subset of adults (n = 153) with moderate or severe asthma participating in a randomized parallel-group, double-dummy trial that compared the efficacy and safety of 12 weeks&amp;rsquo; treatment with budesonide delivered via Respimat&amp;reg; Soft Mist&amp;trade; Inhaler (SMI) (200 or 400 &amp;micro;g bd) or Turbuhaler&amp;reg; dry powder inhaler (400 &amp;micro;g bd), completed a questionnaire on patient device preference and satisfaction (PASAPQ) as part of a psychometric validation. As the study used a double-dummy design to maintain blinding, patients used and assessed both devices, rating their satisfaction with, preference for, and willingness to continue using each device. The mean age of patients was 41 years, 69% were female and the mean duration of disease was 16 years. Total PASAPQ satisfaction scores were 85.5 and 76.9 for Respimat&amp;reg; SMI and Turbuhaler&amp;reg; respectively (p&amp;nbsp;&amp;lt; 0.0001); 112 patients (74%) preferred Respimat&amp;reg; SMI and 26 (17%) preferred Turbuhaler&amp;reg;. Fourteen subjects (9%) indicated no preference for either inhaler. Willingness to continue using Respimat&amp;reg; SMI was higher than that for Turbuhaler&amp;reg; (mean scores: 80/100 and 62/100, respectively). Respimat&amp;reg; SMI was preferred to Turbuhaler&amp;reg; by adult asthma patients who used both devices in a clinical trial setting.Keywords: asthma, Respimat&amp;reg; Soft Mist&amp;trade; Inhaler, Turbuhaler&amp;reg