Burudpakdee Chakkarin, Kushnarev Vladimir, Coppolo Dominic, Suggett Jason A
QuintilesIMS, Fairfax, VA, USA.
University of North Carolina at Charlotte, Charlotte, NC, USA.
Pulm Ther. 2017 Dec;3(2):283-296. doi: 10.1007/s41030-017-0047-1. Epub 2017 Jul 14.
Electrostatic charge in valved holding chambers (VHCs) may lead to inconsistent metered-dose inhaler (MDI) asthma drug delivery. We compared the AeroChamber Plus Flow Vu Antistatic Valved Holding Chamber (ACFV AVHC) with non-antistatic control VHCs in terms of asthma exacerbations, resource use, and cost in an asthma population.
Patients included in an adjudicated claims database with ACFV AVHC or non-antistatic VHC (control VHC) use between 1/2010 and 8/2015 (index) who were treated with an inhaled corticosteroid (ICS) or a combination of an ICS and a long-acting β2 agonist MDI within 60 days before or after the index date, were diagnosed with asthma, and had ≥12 months of pre- and ≥30 days of post-index health plan enrollment were included. Cohorts were matched 1:1 using propensity scores. We compared incidence rates (IR) of exacerbation, time to first exacerbation using Kaplan-Meier survival analysis, occurrence of exacerbations, and healthcare resource use and costs using generalized linear models.
9325 patients in each cohort were identified. The IR of exacerbations per 100 person-days (95% CI) was significantly higher in the control VHC cohort than the ACFV AVHC cohort [0.161 (0.150-0.172) vs. 0.137 (0.128-0.147)]. A higher proportion of exacerbation-free patients was observed in the ACFV AVHC cohort. Among the 4293 patients in each cohort with ≥12 months of follow-up, ACFV AVHC patients were found to be 10-12% less likely than control VHC patients to experience an exacerbation throughout the study period. A lower proportion of the ACFV AVHC patients had an ED visit compared to the control VHC patients (10.8% vs. 12.4%). Exacerbation-related costs for the ACFV AVHC cohort were 23%, 25%, 20%, and 12% lower than those for the control VHC cohort at 1, 6, 9, and 12 months, respectively.
The ACFV AVHC was associated with lower exacerbation rates, delayed time to first exacerbation, and lower exacerbation-related costs when compared to control non-antistatic VHCs.
带阀储物罐(VHCs)中的静电荷可能导致定量吸入器(MDI)哮喘药物递送不一致。我们在哮喘患者群体中,就哮喘加重情况、资源利用和成本方面,将AeroChamber Plus Flow Vu抗静电带阀储物罐(ACFV AVHC)与非抗静电对照VHCs进行了比较。
纳入一个经判定的索赔数据库中的患者,这些患者在2010年1月至2015年8月(索引期)期间使用过ACFV AVHC或非抗静电VHC(对照VHC),在索引日期之前或之后60天内接受过吸入性糖皮质激素(ICS)或ICS与长效β2受体激动剂MDI联合治疗,被诊断为哮喘,并且在索引期前有≥12个月以及索引期后有≥30天的健康计划参保时间。使用倾向得分将队列进行1:1匹配。我们使用Kaplan-Meier生存分析比较了加重发生率(IR)、首次加重时间,使用广义线性模型比较了加重的发生情况、医疗资源利用和成本。
每个队列中确定了9325名患者。对照VHC队列中每100人日的加重IR(95%CI)显著高于ACFV AVHC队列[0.161(0.150 - 0.172)对0.137(0.128 - 0.147)]。在ACFV AVHC队列中观察到无加重患者的比例更高。在每个队列中随访≥12个月的4293名患者中,发现在整个研究期间,ACFV AVHC患者比对照VHC患者发生加重的可能性低10 - 12%。与对照VHC患者相比,ACFV AVHC患者中急诊就诊的比例更低(10.8%对12.4%)。ACFV AVHC队列在1、6、9和12个月时与加重相关的成本分别比对照VHC队列低23%、25%、20%和12%。
与对照非抗静电VHCs相比,ACFV AVHC与更低的加重率、首次加重时间延迟以及更低的加重相关成本相关。