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首页> 外文期刊>BMC Pulmonary Medicine >Time-to-first exacerbation, adherence, and medical costs among US patients receiving umeclidinium/vilanterol or tiotropium as initial maintenance therapy for chronic obstructive pulmonary disease: a retrospective cohort study
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Time-to-first exacerbation, adherence, and medical costs among US patients receiving umeclidinium/vilanterol or tiotropium as initial maintenance therapy for chronic obstructive pulmonary disease: a retrospective cohort study

机译：在慢性阻塞性肺病中接受Umeclidinium / Vilanterol或Tiotropium作为初步维持治疗的美国患者的初始维持治疗的急性维持治疗的初始加剧，依从性和医疗费用：回顾性队列研究

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Adherence to chronic obstructive pulmonary disease (COPD) maintenance medication is important for managing symptoms and exacerbation risk, and is associated with reduced mortality, hospitalizations, and costs. This study compared on-treatment exacerbations, medical costs, and medication adherence in patients with COPD initiating treatment with umeclidinium/vilanterol (UMEC/VI) or tiotropium (TIO). This retrospective matched cohort study selected patients from Optum’s de-identified Clinformatics Data Mart database who initiated maintenance treatment with UMEC/VI or TIO between 01/01/2014 and 12/31/2017 (index date defined as the first dispensing). Eligible patients were?≥?40?years of age and had?≥?12?months continuous health plan coverage pre- and post-index;?≥?1 medical claim for COPD pre-index or on the index date; no moderate/severe COPD-related exacerbations on the index date; no asthma diagnosis pre- or post-index; no maintenance medication fills containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists pre-index or on the index date; and no fills for both UMEC/VI and TIO on the index date. Outcomes included time-to-first (Kaplan–Meier analysis) and rates of on-treatment COPD-related moderate/severe exacerbations, medication adherence (proportion of days covered [PDC] and proportion of adherent patients [PDC?≥?0.8]), and COPD-related medical costs per patient per month (PPPM). Propensity score matching was used to adjust for potential confounders. Each cohort included 3929 matched patients. Kaplan–Meier rates of on-treatment COPD-related exacerbations were similar between cohorts (hazard ratio at 12?months; overall: 0.93, moderate: 0.92, severe: 1.07; all p??0.05). UMEC/VI versus TIO initiators had significantly higher adherence (mean PDC: 0.44 vs 0.37; p??0.001; proportion with PDC?≥?0.8: 22.0% vs 16.4%; p?0.001) and significantly lower mean on-treatment COPD-related total medical costs ($867 vs $1095 PPPM; p?=?0.028), driven by lower outpatient visit costs. These findings provide valuable information for physicians considering UMEC/VI or TIO as initial maintenance therapy options for patients with COPD.
机译：依赖慢性阻塞性肺病（COPD）维持药物治疗对于管理症状和恶化风险是重要的，并且与降低死亡率，住院，住院和成本有关。本研究与COPD引发治疗（UMEC / VI）或噻托溴铵（TIO）相比，对患者的治疗加剧，医疗费用和药物粘附性比较。此回顾性匹配的队列研究选择了来自Optum的De-Idented Clibformatics数据MART数据库的患者，他在01/01/2014和2017年12月1日至12日之间启动了使用UMEC / VI或TIO的维护治疗（被定义为第一次分配的指数日期）。符合条件的患者是≥？40？岁月的≥？≥？12？月份持续健康计划覆盖前和索引后的覆盖率;？≥？1医疗索赔COPD预指数或指数日期;在索引日期上没有适度/严重的COPD相关的恶化;没有哮喘诊断前或索引后;没有含有吸入的皮质类固醇，长效β2-激动剂或长效毒蕈碱拮抗剂的维持药物填充物预指数或指数日期;并且在索引日期上没有填写UMEC / VI和TIO。结果包括第一位（Kaplan-Meier分析）和治疗COPD相关的中/严重加剧，药物粘附（涵盖的天数和粘附患者的比例[PDC吗？≥？0.8]） ，每月每位患者的COPD相关医疗费用（PPPM）。倾向得分匹配用于调整潜在混淆。每个队列都包括3929名患者。 Kaplan-Meier在治疗相关的COPD相关的加剧率与群组（危险比在12个月）之间相似UMEC / VI与TiO引发剂具有显着更高的粘附性（平均PDC：0.44 Vs 0.37;p≤≤0.001;与PDC的比例≥≤0.8：22.0％vs 16.4％; p <0.001），均显着降低治疗COPD相关的医疗费用（867美元vs $ 1095 pppm; p？= 0.028），由较低的门诊访问成本驱动。这些调查结果为考虑UMEC / VI或TIO作为COPD患者的初始维护治疗选择提供了有价值的信息。

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