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Buikema AR, Brekke L, Anderson A, et al. The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models. Multidiscip Respir Med. 2018;13:38doi: 10.1186/s40248-018-0151-6.
Buikema, A. R., Brekke, L., Anderson, A., Koep, E., Van Voorhis, D., Sharpsten, L., Hahn, B., Ray, R., & Stanford, R. H. (2018). The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models. Multidisciplinary respiratory medicine, 1338. https://doi.org/10.1186/s40248-018-0151-6
Buikema, Ami R, et al. "The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models." Multidisciplinary respiratory medicine vol. 13 (2018): 38. doi: https://doi.org/10.1186/s40248-018-0151-6
Buikema AR, Brekke L, Anderson A, Koep E, Van Voorhis D, Sharpsten L, Hahn B, Ray R, Stanford RH. The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models. Multidiscip Respir Med. 2018 Oct 11;13:38. doi: 10.1186/s40248-018-0151-6. eCollection 2018. PMID: 30338068; PMCID: PMC6180385.
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Multidiscip Respir Med. 2018 Oct 11;13:38. doi: 10.1186/s40248-018-0151-6. eCollection 2018.

The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models.

Multidisciplinary respiratory medicine

Ami R Buikema, Lee Brekke, Amy Anderson, Eleena Koep, Damon Van Voorhis, Lucie Sharpsten, Beth Hahn, Riju Ray, Richard H Stanford

Affiliations

  1. 1Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA.
  2. 2US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398 USA.
  3. 3US Medical Affairs, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398 USA.

PMID: 30338068 PMCID: PMC6180385 DOI: 10.1186/s40248-018-0151-6

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with high clinical and economic burden. Optimal pharmacological therapy for COPD aims to reduce symptoms and the frequency and severity of exacerbations. Umeclidinium/vilanterol (UMEC/VI) is an approved combination therapy for once-daily maintenance treatment of patients with COPD. This study evaluated the impact of delaying UMEC/VI initiation on medical costs and exacerbation risk.

METHODS: A retrospective analysis of patients with COPD who initiated UMEC/VI between 4/28/2014 and 7/31/2016 was conducted using the Optum Research Database. The index date was the first COPD visit after UMEC/VI available on US formulary (Commercial 4/28/2014; Medicare Advantage 1/1/2015). Patients were followed for 12 months post-index, and categorized into 12 cohorts corresponding to month (30-day period) of UMEC/VI initiation (i.e. Months 1-12) post-index. The outcomes studied during the follow up period included COPD-related and all-cause medical costs, and risk of COPD exacerbations. Marginal structural models (MSM) were used to control for time-varying confounding due to changes in treatment and severity during follow up.

RESULTS: 2,200 patients initiating UMEC/VI were included in the study sample. Patients' average age was 69.3 years, 49.9% were female and 69.7% were Medicare insured. Following MSM analysis, 12-month adjusted COPD-related medical costs increased by 2.9% (95% confidence interval [CI]: 0.1-5.9%;

CONCLUSIONS: Prompt use of UMEC/VI following a physician visit for COPD appears to result in economic and clinical benefits, with reductions in medical costs and exacerbation risk. Additional research is warranted to assess the benefits of initiating UMEC/VI as a first-line therapy compared with escalation to UMEC/VI from monotherapies.

Keywords: COPD; Costs; Exacerbation; Marginal structural model; Time-varying confounding; Umeclidinium/vilanterol

Conflict of interest statement

This study utilized de-identified retrospective claims data, and as such, this study does not require institutional review board (IRB) review and approval or informed consent procedures. This study is

References

  1. Respir Res. 2013 May 08;14:49 - PubMed
  2. Int J Chron Obstruct Pulmon Dis. 2017 Feb 24;12:745-755 - PubMed
  3. Stat Med. 2002 Jun 30;21(12):1689-709 - PubMed
  4. Int J Chron Obstruct Pulmon Dis. 2016 Feb 04;11:193-205 - PubMed
  5. Int J Chron Obstruct Pulmon Dis. 2016 Jan 18;11:123-32 - PubMed
  6. Chest. 2004 Jan;125(1):249-59 - PubMed
  7. Am J Epidemiol. 2008 Sep 15;168(6):656-64 - PubMed
  8. Int J Chron Obstruct Pulmon Dis. 2017 Mar 24;12:997-1008 - PubMed
  9. Int J Chron Obstruct Pulmon Dis. 2015 Jun 05;10:1015-26 - PubMed
  10. Thorax. 2012 Nov;67(11):957-63 - PubMed
  11. Eur Respir J. 2004 Jun;23(6):932-46 - PubMed
  12. Cost Eff Resour Alloc. 2015 Dec 12;13:22 - PubMed
  13. Natl Vital Stat Rep. 2013 Dec 20;62(6):1-96 - PubMed
  14. BMC Pulm Med. 2015 Aug 19;15:91 - PubMed
  15. Pharmacoeconomics. 2012 Oct 1;30(10):869-85 - PubMed
  16. Int J Chron Obstruct Pulmon Dis. 2016 May 09;11:971-9 - PubMed
  17. Respir Med. 2013 Oct;107(10):1538-46 - PubMed
  18. Lancet Respir Med. 2014 Jun;2(6):472-86 - PubMed
  19. Value Health. 2014 Nov;17(7):A595 - PubMed
  20. MMWR Morb Mortal Wkly Rep. 2015 Mar 27;64(11):289-95 - PubMed
  21. Respir Med. 2015 Jul;109(7):870-81 - PubMed
  22. Lancet Respir Med. 2013 Mar;1(1):51-60 - PubMed
  23. Respir Med. 2016 Mar;112:65-74 - PubMed
  24. Pharmacol Rev. 2012 Jul;64(3):450-504 - PubMed
  25. Chronic Obstr Pulm Dis. 2017 Jul 15;4(3):177-185 - PubMed
  26. Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55 - PubMed
  27. Clin Ther. 2008;30 Spec No:1003-16 - PubMed
  28. Chest. 2015 Jan;147(1):31-45 - PubMed
  29. Epidemiology. 2000 Sep;11(5):550-60 - PubMed
  30. Respir Med. 2014 Dec;108(12):1752-60 - PubMed
  31. Respirology. 2016 Jan;21(1):14-23 - PubMed
  32. N Engl J Med. 2010 Sep 16;363(12):1128-38 - PubMed
  33. Epidemiology. 2000 Sep;11(5):561-70 - PubMed

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