在合并 COPD/抑郁的患者中，起始使用丙酸氟替卡松/沙美特罗复方制剂（250/50 mcg）与抗胆碱能药物相比的临床和经济结局。

Clinical and economic outcomes for patients initiating fluticasone propionate/salmeterol combination therapy (250/50 mcg) versus anticholinergics in a comorbid COPD/depression population.

机构信息

GlaxoSmithKline, Research Triangle Park, NC, USA.

出版信息

Int J Chron Obstruct Pulmon Dis. 2012;7:11-9. doi: 10.2147/COPD.S27846. Epub 2012 Jan 18.

DOI:10.2147/COPD.S27846

PMID:22315518

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3273366/

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is frequently associated with comorbid depression and anxiety. Managing COPD symptoms and exacerbations through use of appropriate and adequate pharmacotherapy in this population may result in better COPD-related outcomes.

METHODS

This retrospective, observational study used administrative claims of patients aged 40 years and older with COPD and comorbid depression/anxiety identified from January 1, 2004 through June 30, 2008. Patients were assigned to fluticasone propionate/salmeterol 250/50 mcg combination (FSC) or anticholinergics (AC) based on their first (index) prescription. The risks of COPD exacerbations and healthcare utilization and costs were compared between cohorts during 1 year of follow-up.

RESULTS

The adjusted risk of a COPD-related exacerbation during the 1-year follow-up period was 30% higher in the AC cohort (n = 2923) relative to the FSC cohort (n = 1078) (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.08-1.56) after controlling for baseline differences in covariates. The risks of COPD-related hospitalizations and emergency department visits were 56% and 65% higher, respectively, in the AC cohort compared with the FSC cohort. The average number of COPD-related hospitalizations during the follow-up period was 46% higher for the AC cohort compared with the FSC cohort (incidence rate ratio [IRR]: 1.46, 95% CI: 1.01-2.09, P = 0.041). The savings from lower COPD-related medical costs ($692 vs $1042, P < 0.050) kept the COPD-related total costs during the follow-up period comparable to those in the AC cohort ($1659 vs $1677, P > 0.050) although the pharmacy costs were higher in the FSC cohort.

CONCLUSIONS

FSC compared with AC was associated with more favorable COPD-related outcomes and lower COPD-related utilization and medical costs among patients with COPD and comorbid anxiety/depression.

摘要

背景

慢性阻塞性肺疾病（COPD）常伴有共病性抑郁和焦虑。在这一人群中，通过使用适当和充分的药物治疗来控制 COPD 症状和加重，可能会带来更好的 COPD 相关结局。

方法

本回顾性观察性研究使用了从 2004 年 1 月 1 日至 2008 年 6 月 30 日期间年龄在 40 岁及以上的伴有共病性抑郁/焦虑的 COPD 患者的行政索赔数据。根据患者的首诊（索引）处方，将患者分为丙酸氟替卡松/沙美特罗 250/50mcg 复方制剂（FSC）或抗胆碱能药物（AC）组。在 1 年的随访期间，比较了两组 COPD 加重和医疗保健利用情况以及成本。

结果

在调整了基线协变量差异后，AC 组（n=2923）在 1 年随访期间 COPD 相关加重的风险比 FSC 组（n=1078）高 30%（比值比[OR]：1.30，95%置信区间[CI]：1.08-1.56）。与 FSC 组相比，AC 组 COPD 相关住院和急诊就诊的风险分别高 56%和 65%。在随访期间，AC 组 COPD 相关住院次数平均高 46%（发病率比[IRR]：1.46，95%CI：1.01-2.09，P=0.041）。由于 COPD 相关医疗成本较低（$692 与 $1042，P < 0.050），节省了成本，使 FSC 组在随访期间的 COPD 相关总成本与 AC 组相当（$1659 与 $1677，P > 0.050），尽管 FSC 组的药房成本更高。