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Davis JR, Wu B, Kern DM, et al. Impact of Nonadherence to Inhaled Corticosteroid/LABA Therapy on COPD Exacerbation Rates and Healthcare Costs in a Commercially Insured US Population. Am Health Drug Benefits. 2017;10(2):92-102
Davis, J. R., Wu, B., Kern, D. M., Tunceli, O., Fox, K. M., Horton, J., Legg, R. F., & Trudo, F. (2017). Impact of Nonadherence to Inhaled Corticosteroid/LABA Therapy on COPD Exacerbation Rates and Healthcare Costs in a Commercially Insured US Population. American health & drug benefits, 10(2), 92-102.
Davis, Jill R, et al. "Impact of Nonadherence to Inhaled Corticosteroid/LABA Therapy on COPD Exacerbation Rates and Healthcare Costs in a Commercially Insured US Population." American health & drug benefits vol. 10,2 (2017): 92-102.
Davis JR, Wu B, Kern DM, Tunceli O, Fox KM, Horton J, Legg RF, Trudo F. Impact of Nonadherence to Inhaled Corticosteroid/LABA Therapy on COPD Exacerbation Rates and Healthcare Costs in a Commercially Insured US Population. Am Health Drug Benefits. 2017 Apr;10(2):92-102. PMID: 28626506; PMCID: PMC5470247.
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Am Health Drug Benefits. 2017 Apr;10(2):92-102.

Impact of Nonadherence to Inhaled Corticosteroid/LABA Therapy on COPD Exacerbation Rates and Healthcare Costs in a Commercially Insured US Population.

American health & drug benefits

Jill R Davis, Bingcao Wu, David M Kern, Ozgur Tunceli, Kathleen M Fox, John Horton, Randall F Legg, Frank Trudo

Affiliations

  1. Director, Health Economics and Outcomes Research, AstraZeneca R&D, Wilmington, DE.
  2. Associate Director, RWE Design & Analytics, Janssen Pharmaceuticals, and was Associate Director, HealthCore, Wilmington, DE, at the time of the study.
  3. Director of Research, HealthCore.
  4. Director, RWE Design & Analytics, Janssen Pharmaceuticals, and was Director of Research, HealthCore, at the time of the study.
  5. Director of Health Economics Outcomes Research, AstraZeneca, and is currently with Strategic Healthcare Solutions.
  6. Employees of AstraZeneca R&D at the time of the study.
  7. Medical Lead - Respiratory, AstraZeneca US Medical Affairs.

PMID: 28626506 PMCID: PMC5470247

Abstract

BACKGROUND: Evidence of poor patient adherence to medications for chronic obstructive pulmonary disease (COPD) is well-documented, but its impact on disease exacerbation rates and associated healthcare costs remains unclear.

OBJECTIVE: To assess the association between adherence levels to different inhaled corticosteroid/long-acting ß

METHODS: In this observational cohort study, patients with COPD (aged ≥40 years) who were treatment-naïve to inhaled corticosteroid/LABA and were initiating budesonide plus formoterol or fluticasone plus salmeterol between March 1, 2009, and January 31, 2014, were identified in a national representative claims database and were followed for up to 12 months. The date of the first prescription fill for either drug was defined as the index date. Patients were divided into 4 cohorts based on adherence to the index therapy, which was measured by proportion of days covered (PDC); the cohorts were classified as adherent (PDC ≥0.8), mildly nonadherent (0.5 ≤ PDC <0.8), moderately nonadherent (0.3 ≤ PDC <0.5), and highly nonadherent (PDC <0.3). Each nonadherent group was matched in a 1:1 ratio to the adherent group independently, based on prognostically important variables, using propensity score analyses. Exacerbation rates and healthcare costs were analyzed for 1 year after treatment initiation.

RESULTS: During the study period, 13,657 eligible patients with COPD initiated inhaled corticosteroid/LABA; of these, only 1898 (13.9%) patients were adherent during follow-up. Group matching resulted in 1572 patients per group for comparison 1 (adherent vs mildly nonadherent), 1604 patients for comparison 2 (adherent vs moderately nonadherent), and 1755 patients for comparison 3 (adherent vs highly nonadherent). The moderately and highly nonadherent cohorts had higher exacerbation rates than the adherent patients (comparison 2: rate ratio [RR], 1.11; 95% confidence interval [CI], 1.01-1.21;

CONCLUSIONS: Patients adhered to their inhaled corticosteroid/LABA treatments had lower COPD exacerbation rates and lower healthcare costs compared with the moderately and highly nonadherent patients. Better adherence to maintenance therapies may help to reduce the clinical and economic burdens of COPD.

Keywords: COPD; adherence; cost; disease exacerbation; economic burden; inhaled corticosteroid/LABA; nonadherence; propensity score matching; proportion of days covered

References

  1. Am J Respir Crit Care Med. 2001 Apr;163(5):1256-76 - PubMed
  2. Respir Res. 2013 Oct 20;14:109 - PubMed
  3. Am J Respir Crit Care Med. 2013 Feb 15;187(4):347-65 - PubMed
  4. Cochrane Database Syst Rev. 2014 Mar 19;(3):CD002990 - PubMed
  5. Stat Med. 2005 May 30;24(10):1563-78 - PubMed
  6. Int J Chron Obstruct Pulmon Dis. 2010 Nov 24;5:401-6 - PubMed
  7. Thorax. 2013 Jan;68(1):48-56 - PubMed
  8. Respir Res. 2011 Jan 13;12:7 - PubMed
  9. Osteoarthritis Cartilage. 2012 Aug;20(8):805-8 - PubMed
  10. Am J Epidemiol. 2010 Nov 1;172(9):1092-7 - PubMed
  11. J Manag Care Pharm. 2009 Jul-Aug;15(6):501-7 - PubMed
  12. BMC Health Serv Res. 2011 Nov 28;11:326 - PubMed
  13. Clin Ther. 1999 Jun;21(6):1074-90; discussion 1073 - PubMed
  14. Int J Chron Obstruct Pulmon Dis. 2015 Mar 16;10:549-64 - PubMed
  15. Value Health. 2005 Jan-Feb;8(1):67-79 - PubMed
  16. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-84 - PubMed
  17. MMWR Surveill Summ. 2002 Aug 2;51(6):1-16 - PubMed
  18. Patient Educ Couns. 2007 Apr;66(1):29-36 - PubMed
  19. Am J Manag Care. 2005 Jul;11(7):449-57 - PubMed
  20. Int J Chron Obstruct Pulmon Dis. 2011;6:321-8 - PubMed
  21. Cochrane Database Syst Rev. 2014 Mar 26;(3):CD010844 - PubMed
  22. Patient Prefer Adherence. 2015 Feb 02;9:235-42 - PubMed
  23. Stat Med. 2008 May 30;27(12):2037-49 - PubMed
  24. Respiration. 2011;82(4):328-34 - PubMed
  25. Am Health Drug Benefits. 2017 Apr;10(2):92-102 - PubMed
  26. Value Health. 2009 Nov-Dec;12(8):1062-73 - PubMed
  27. Natl Vital Stat Rep. 2012 Oct 10;61(6):1-51 - PubMed
  28. Ann Pharmacother. 2006 Jul-Aug;40(7-8):1280-88 - PubMed

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