Impact of Therapy Persistence on Exacerbations and Resource Use in Patients Who Initiated COPD Therapy

• Published in: International journal of chronic obstructive pulmonary disease Vol. 14; pp. 2905 - 2915
• Main Authors: Dalon, Faustine, Devouassoux, Gilles, Belhassen, Manon, Nachbaur, Gaëlle, Correia Da Silva, Camille, Sail, Lynda, Jacoud, Flore, Chouaid, Christos, Van Ganse, Eric
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.12.2019; Dove Medical Press Ltd; Dove Medical Press; Dove
• Subjects: Age; Antibiotics; Asthma; Care and treatment; Chest x-rays; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Codes; Comparative analysis; copd; Corticosteroid drugs; Diagnosis related groups; DRGs; exacerbations; Family physicians; Generalized linear models; Glucocorticoids; healthcare resource use; Hospitalization; Hospitals; Human health and pathology; Inhalers; Life Sciences; Lung diseases; Medical research; Original Research; Oxygen therapy; Patient compliance; Patients; persistence; Population; Pulmonary function tests; Pulmonology and respiratory tract; Sociodemographics; Steroids; therapy; X-rays; France; healthcare resource use; persistence; exacerbations; therapy; COPD
• DOI: 10.2147/COPD.S222762
• ISSN: 1178-2005; 1176-9106

This study assessed therapy persistence in patients with chronic obstructive pulmonary disease (COPD) in France, and the impact of non-persistence on exacerbations and described COPD-related healthcare resource use (HRU). Patients aged ≥45 years who received ≥1 dispensed bronchodilator per quarter over three consecutive quarters between 2007 and 2014 and initiated specific COPD therapy were selected from the Echantillon Généraliste des Bénéficiaires (EGB) database. Persistence, defined as the absence of dispensing gaps of >90 days, was measured at 12 months. Exacerbations were compared between persistent and non-persistent patients during follow-up after patient matching and adjustment for confounding factors. COPD-related HRU during follow-up was described. Among 4020 patients with COPD, 2164 initiated a specific therapy. Of these, 54.4% stopped treatment within 12 months. Persistence with all COPD therapy regimens was low, particularly for inhaled corticosteroid (ICS; 25.6%) and ICS/twice-daily long-acting beta-agonist (39.4%) regimens. Among 721 persistent patients who were matched with 721 non-persistent patients, there was no difference in the number of moderate or severe exacerbations at 12 months. However, medical procedures (for instance, pulmonary function testing and chest X-rays) were more frequently observed among persistent patients than among non-persistent patients, suggesting worse disease severity. Patients receiving specific treatment(s) for COPD demonstrated low persistence for all examined therapy regimens, with no clear impact of persistence status on the frequency of exacerbations at 12 months.