AstraZeneca, Gothenburg, Sweden.
Practice Fusion, San Francisco, CA, USA.
Int J Chron Obstruct Pulmon Dis. 2020 Apr 16;15:775-786. doi: 10.2147/COPD.S238408. eCollection 2020.
This retrospective, observational cohort study utilized an integrated dataset from an electronic health records system and a claims database to describe demographic and clinical characteristics, healthcare resource utilization (HCRU), and treatment patterns in COPD patients initiating long-acting muscarinic antagonist (LAMA)/long-acting β-agonist (LABA) fixed-dose combination (FDC) treatment in the USA.
Patients were aged ≥40 years and had a COPD diagnosis (Practice Fusion system) and ≥1 prescription of LAMA/LABA FDC therapy, with an index date (first prescription) 1 May 2014-31 December 2017. For the HCRU analysis, patients had ≥2 claims from the Symphony Health database within 12 months before index. All analyses of outcomes relating to demographic and clinical characteristics, HCRU, and treatment patterns were descriptive.
Patients initiating LAMA/LABA FDCs (n=8224) had a mean age of 67.9 years, 52.8% were female, and mean BMI was 29.2 kg/m. The most common comorbidities were cardiovascular disease (74.3%), hypertension (64.0%), and hyperlipidemia (45.6%). In the 12 months prior to index, 53.1% of patients had used inhaled therapy: 23.4% short-acting therapy only, 16.7% short-acting and maintenance therapy, and 13.1% maintenance therapy only. Amongst users of inhaled therapies, the pMDI was the most frequently used device (64.3%, n=2812/4370). Of 7050 patients included in the HCRU analysis, 79.8% had COPD-related costs; mean cost/patient was $4174. Mean COPD-related costs per patient for moderate and severe exacerbations were $910 and $23,208, respectively. Per-patient costs included $23,032 for inpatient visits, $2358 for emergency visits, $4432 for outpatient visits, and $1989 for pharmacy claims.
This observational study is the first to describe the real-world demographic and clinical characteristics and HCRU of patients initiating LAMA/LABA FDC treatment in the USA. Patients were generally elderly and overweight, with comorbidities of CVD, hypertension, and hyperlipidemia. Inpatient visits were the largest contributor to COPD-related costs per patient in the year prior to initiation of LAMA/LABA FDCs.
本回顾性观察队列研究利用电子病历系统和理赔数据库的综合数据集，描述了美国开始使用长效毒蕈碱拮抗剂（LAMA）/长效β-激动剂（LABA）固定剂量复方制剂（FDC）治疗的 COPD 患者的人口统计学和临床特征、医疗资源利用（HCRU）和治疗模式。
患者年龄≥40 岁，有 COPD 诊断（Practice Fusion 系统）和≥1 次 LAMA/LABA FDC 治疗处方，索引日期（首次处方）为 2014 年 5 月 1 日至 2017 年 12 月 31 日。对于 HCRU 分析，患者在索引前 12 个月内至少有 2 次来自 Symphony Health 数据库的理赔。与人口统计学和临床特征、HCRU 和治疗模式相关的所有结局分析均为描述性分析。
开始使用 LAMA/LABA FDC 的患者（n=8224）平均年龄为 67.9 岁，52.8%为女性，平均 BMI 为 29.2kg/m2。最常见的合并症是心血管疾病（74.3%）、高血压（64.0%）和高血脂（45.6%）。在索引前 12 个月，53.1%的患者使用了吸入疗法：23.4%仅使用短效疗法，16.7%使用短效和维持疗法，13.1%仅使用维持疗法。在使用吸入疗法的患者中，pMDI 是最常使用的装置（64.3%，n=2812/4370）。在纳入 HCRU 分析的 7050 名患者中，79.8%有 COPD 相关费用；每位患者的平均费用为 4174 美元。中重度加重的 COPD 相关费用分别为 910 美元和 23208 美元。每位患者的费用包括住院治疗费用 23032 美元、急诊治疗费用 2358 美元、门诊治疗费用 4432 美元和药品费用 1989 美元。
本观察性研究首次描述了美国开始使用 LAMA/LABA FDC 治疗的患者的真实世界人口统计学和临床特征以及 HCRU。患者通常年龄较大且超重，合并有 CVD、高血压和高血脂等疾病。在开始使用 LAMA/LABA FDC 之前的一年中，住院治疗是每位患者 COPD 相关费用的最大贡献者。
