Beth Hahn1, Michael Hull2, Cori Blauer-Peterson3, Ami R Buikema4, Riju Ray5, Richard H Stanford6. 1. US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398, USA. Electronic address: beth.a.hahn@gsk.com. 2. Health Economics and Outcomes Research, Optum LifeSciences, 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA. Electronic address: michael.hull@optum.com. 3. Health Economics and Outcomes Research, Optum LifeSciences, 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA. Electronic address: cori.blauer@optum.com. 4. Health Economics and Outcomes Research, Optum LifeSciences, 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA. Electronic address: Ami.Buikema@optum.com. 5. US Medical Affairs, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398, USA. Electronic address: riju.x.ray@gsk.com. 6. US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398, USA. Electronic address: richard.h.stanford@gsk.com.
Abstract
BACKGROUND: Improved outcomes have been reported for patients with chronic obstructive pulmonary disease (COPD) receiving combination long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) therapy compared with LAMA monotherapy. However, little is known about the relative characteristics of these patients and their rates of escalation to triple therapy (TT, combining a LAMA, LABA, and inhaled corticosteroid). This study aimed to characterize patients initiating treatment with the LAMA tiotropium (TIO) and the fixed-dose LAMA/LABA combination therapy umeclidinium/vilanterol (UMEC/VI), and to compare rates of escalation to TT between patients receiving these therapies. METHODS: Retrospective study of patients with COPD enrolled in a US health insurance plan during 2013-2015 and newly initiated on TIO or UMEC/VI. Patients were ≥40 years of age at index (date of therapy initiation) with continuous enrollment for 12 months pre-index and ≥30 days post-index. LAMA users were propensity score matched 1:1 to LAMA/LABA users, with TT initiation rates reported by cohort using pharmacy claims. RESULTS: 35,357 patients initiating on TIO and 2407 patients initiating on UMEC/VI were identified. After propensity score matching, the rate of TT initiation was significantly higher in new TIO users (n = 1320) than in new UMEC/VI users (n = 1320) (0.92 vs 0.49 per 100 months of exposure, respectively; p < 0.001). Relative to the UMEC/VI cohort, the TIO cohort had an 87% higher risk of TT initiation (hazard ratio: 1.87; 95% confidence interval: 1.4-2.5; p = 0.001). CONCLUSIONS: Patients receiving UMEC/VI progressed to TT more slowly, and were at lower risk of progressing to TT, than patients receiving TIO.
BACKGROUND: Improved outcomes have been reported for patients with chronic obstructive pulmonary disease (COPD) receiving combination long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) therapy compared with LAMA monotherapy. However, little is known about the relative characteristics of these patients and their rates of escalation to triple therapy (TT, combining a LAMA, LABA, and inhaled corticosteroid). This study aimed to characterize patients initiating treatment with the LAMA tiotropium (TIO) and the fixed-dose LAMA/LABA combination therapy umeclidinium/vilanterol (UMEC/VI), and to compare rates of escalation to TT between patients receiving these therapies. METHODS: Retrospective study of patients with COPD enrolled in a US health insurance plan during 2013-2015 and newly initiated on TIO or UMEC/VI. Patients were ≥40 years of age at index (date of therapy initiation) with continuous enrollment for 12 months pre-index and ≥30 days post-index. LAMA users were propensity score matched 1:1 to LAMA/LABA users, with TT initiation rates reported by cohort using pharmacy claims. RESULTS: 35,357 patients initiating on TIO and 2407 patients initiating on UMEC/VI were identified. After propensity score matching, the rate of TT initiation was significantly higher in new TIO users (n = 1320) than in new UMEC/VI users (n = 1320) (0.92 vs 0.49 per 100 months of exposure, respectively; p < 0.001). Relative to the UMEC/VI cohort, the TIO cohort had an 87% higher risk of TT initiation (hazard ratio: 1.87; 95% confidence interval: 1.4-2.5; p = 0.001). CONCLUSIONS:Patients receiving UMEC/VI progressed to TT more slowly, and were at lower risk of progressing to TT, than patients receiving TIO.
Authors: Timothy E Albertson; Willis S Bowman; Richart W Harper; Regina M Godbout; Susan Murin Journal: Int J Chron Obstruct Pulmon Dis Date: 2019-06-06
Authors: Chad Moretz; Lucie Sharpsten; Lindsay Gs Bengtson; Eleena Koep; Lisa Le; Junliang Tong; Richard H Stanford; Beth Hahn; Riju Ray Journal: Int J Chron Obstruct Pulmon Dis Date: 2019-08-01
Authors: Chad Moretz; Lindsay Gs Bengtson; Lucie Sharpsten; Eleena Koep; Lisa Le; Junliang Tong; Richard H Stanford; Beth Hahn; Riju Ray Journal: Int J Chron Obstruct Pulmon Dis Date: 2019-09-04
Authors: Anna Schultze; Alex J Walker; Brian MacKenna; Caroline E Morton; Krishnan Bhaskaran; Jeremy P Brown; Christopher T Rentsch; Elizabeth Williamson; Henry Drysdale; Richard Croker; Seb Bacon; William Hulme; Chris Bates; Helen J Curtis; Amir Mehrkar; David Evans; Peter Inglesby; Jonathan Cockburn; Helen I McDonald; Laurie Tomlinson; Rohini Mathur; Kevin Wing; Angel Y S Wong; Harriet Forbes; John Parry; Frank Hester; Sam Harper; Stephen J W Evans; Jennifer Quint; Liam Smeeth; Ian J Douglas; Ben Goldacre Journal: Lancet Respir Med Date: 2020-09-24 Impact factor: 30.700