A US database study characterizing patients initiating a budesonide-formoterol combination versus tiotropium bromide as initial maintenance therapy for chronic obstructive pulmonary disease

• Published in: International journal of chronic obstructive pulmonary disease Vol. 9; no. default; pp. 775 - 783
• Main Authors: Kern, David M, Williams, Setareh A, Tunceli, Ozgur, Wessman, Catrin, Zhou, Siting, Pethick, Ned, Elhefni, Hanaa, Trudo, Frank
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2014; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Adrenergic beta-2 Receptor Agonists - adverse effects; Adrenergic beta-2 Receptor Agonists - economics; Adrenergic beta-2 Receptor Agonists - therapeutic use; Adult; Age Factors; Aged; Asthma; Body mass index; Bronchodilator Agents - adverse effects; Bronchodilator Agents - economics; Bronchodilator Agents - therapeutic use; Budesonide; Budesonide - adverse effects; Budesonide - economics; Budesonide - therapeutic use; Chi-Square Distribution; Cholinergic Antagonists - adverse effects; Cholinergic Antagonists - economics; Cholinergic Antagonists - therapeutic use; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Codes; Combination drug therapy; Comorbidity; Confidence intervals; Consumer-driven health plans; Costs; Cross-Sectional Studies; Data Mining; Databases, Factual; Demographics; Dosage and administration; Drug Combinations; Drug Costs; Drug therapy; Ethanolamines - adverse effects; Ethanolamines - economics; Ethanolamines - therapeutic use; Female; Formoterol; Formoterol Fumarate; Gastroesophageal reflux; Generic products; Glucocorticoids - adverse effects; Glucocorticoids - economics; Glucocorticoids - therapeutic use; Health Expenditures; Health maintenance organizations; Health services utilization; HMOs; Humans; Male; Methods; Middle Aged; Observational studies; Odds Ratio; Original Research; Pharmacy; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Scopolamine Derivatives - adverse effects; Scopolamine Derivatives - economics; Scopolamine Derivatives - therapeutic use; Sex Factors; Steroids; Time Factors; Tiotropium; Tiotropium Bromide; Treatment Outcome; United States - epidemiology; Variables; United States; United States > US; retrospective analysis; chronic respiratory condition; outcome research; health care utilization and costs; observational study
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S64491

To compare clinical and demographic characteristics, resource utilization and costs of chronic obstructive pulmonary disease (COPD) patients prior to initiating budesonide-formoterol combination (BFC) or tiotropium-maintenance therapy. This cross-sectional study used claims-based diagnosis to identify COPD patients in the HealthCore Integrated Research Database who initiated BFC or tiotropium therapy between March 1, 2009 and January 31, 2012 (intake period); the index date was defined as the initial prescription fill for either agent. Patients diagnosed with respiratory tract cancer or receiving inhaled corticosteroids/long-acting β2-adrenergic agonists or tiotropium in 12 months prior to index date were excluded. Categorical variables were evaluated with χ(2) tests; mean cost differences were evaluated using γ-regression. Overall, 6,940 BFC and 10,831 tiotropium patients were identified. The BFC group was younger (mean age 64 versus 67 years), with a greater proportion of females (54% versus 51%). BFC-treated patients had more comorbid respiratory conditions, including asthma (25% versus 13%), but fewer comorbid cardiovascular conditions, including atherosclerosis (7% versus 10%) and myocardial infarction (4% versus 6%). A greater proportion of BFC patients received prior respiratory medication, including oral corticosteroids (46% versus 35%) and short-acting β2-agonists (44% versus 35%). Tiotropium-treated patients had a greater mean number of COPD-related outpatient visits (4.6 versus 4.1). BFC-treated patients had lower total all-cause ($17,259 versus $17,926) and COPD-related ($1,718 versus $1,930) health care costs, driven by lower all-cause and COPD-related inpatient expenditures. Initiators of BFC or tiotropium showed differences in clinical and demographic characteristics and health care utilization and costs prior to starting COPD maintenance therapy.