Epidemiology, Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA.
Observational Research, Adelphi Real World, Bollington, UK.
Int J Chron Obstruct Pulmon Dis. 2021 Oct 8;16:2795-2808. doi: 10.2147/COPD.S312853. eCollection 2021.
To assess if early multiple-inhaler triple therapy (MITT) initiation in patients with chronic obstructive pulmonary disease (COPD) reduces subsequent healthcare resource utilization (HCRU), direct medical costs, and acute exacerbations of COPD (AECOPDs).
This retrospective, longitudinal cohort study used electronic health records and linked hospital administrative data in England. COPD patients with an AECOPD between July 2012 and May 2016 (index), and who subsequently started MITT within 180 days were eligible. Patients with an AECOPD 6 months prior to index were excluded. HCRU, direct healthcare costs, and AECOPDs were assessed in the following 24-month period for early (≤30 days) and delayed (31-180 days) MITT initiators.
A total of 934 patients were included in the analysis and categorized as early (n=367, 39%) or delayed (n=567, 61%) MITT initiators. Mean patient age was 68.5 years and 53.2% were male. A significantly higher proportion of delayed MITT initiators required ≥1 outpatient appointment (all-cause) compared with early MITT initiators (87% vs 79%; p=0.0016). A significantly higher proportion of delayed MITT initiators required ≥1 COPD‑related inpatient stay versus early MITT initiators (47% vs 40%; p=0.0262). Over the 24-month follow-up, mean all-cause and COPD-related total healthcare costs were significantly higher in delayed MITT initiators compared with early MITT initiators (all‑cause: £11,348 vs £8126; p=0.0011; COPD-related: £7307 vs £4535; p=0.0009).
Delayed initiation of multiple-inhaler triple therapy was associated with higher all-cause and COPD-related costs, suggesting that earlier initiation of triple therapy in COPD patients may help reduce the economic burden on the healthcare system.
评估慢性阻塞性肺疾病（COPD）患者早期三联吸入疗法（MITT）的启动是否能降低随后的医疗资源利用（HCRU）、直接医疗费用和 COPD 急性加重（AECOPD）的发生。
本回顾性、纵向队列研究使用了英国的电子健康记录和相关医院行政数据。2012 年 7 月至 2016 年 5 月期间患有 AECOPD（索引），并在 180 天内开始 MITT 的患者符合条件。索引前 6 个月患有 AECOPD 的患者被排除在外。在接下来的 24 个月中，评估了早期（≤30 天）和延迟（31-180 天）MITT 启动患者的 HCRU、直接医疗费用和 AECOPD。
共有 934 名患者纳入分析，分为早期（n=367，39%）或延迟（n=567，61%）MITT 启动者。患者平均年龄为 68.5 岁，53.2%为男性。与早期 MITT 启动者相比，延迟 MITT 启动者需要≥1 次门诊（所有原因）的比例明显更高（87%比 79%；p=0.0016）。延迟 MITT 启动者需要≥1 次 COPD 相关住院治疗的比例明显高于早期 MITT 启动者（47%比 40%；p=0.0262）。在 24 个月的随访中，与早期 MITT 启动者相比，延迟 MITT 启动者的全因和 COPD 相关总医疗费用明显更高（全因：£11348 比 £8126；p=0.0011；COPD 相关：£7307 比 £4535；p=0.0009）。
延迟启动三联吸入疗法与更高的全因和 COPD 相关费用相关，这表明 COPD 患者更早启动三联疗法可能有助于减轻医疗系统的经济负担。
