Life Sciences, IBM Watson Health, Cambridge, MA, USA.
Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois College of Pharmacy, Chicago, IL, USA.
Int J Chron Obstruct Pulmon Dis. 2022 Feb 10;17:329-342. doi: 10.2147/COPD.S347735. eCollection 2022.
Patients with chronic obstructive pulmonary disease (COPD) may experience moderate (requiring outpatient care) or severe (requiring hospitalization) disease exacerbations. Guidelines recommend escalation from dual to triple therapy (inhaled corticosteroid + long-acting beta agonist + long-acting muscarinic antagonist) after two moderate or one severe exacerbation in a year. This study examined whether prompt initiation of triple therapy lowers risk of future exacerbations and reduces healthcare costs, compared to delayed/very delayed triple therapy after an exacerbation.
This retrospective observational study of US healthcare claims included patients ≥40 years old with COPD who initiated triple therapy (1/1/2011-3/31/2020) after ≥2 moderate or ≥1 severe exacerbation in the prior year. The earliest of the second moderate or first severe exacerbation was the index date. Patients were stratified by triple therapy timing: prompt (≤30 days post-index), delayed (31-180 days), very delayed (181-365 days). COPD exacerbations, all-cause and COPD-related healthcare utilization and costs were assessed during 12 months post-index (follow-up). Multivariable regression estimated the effect of each 30-day delay in triple therapy on the odds of exacerbations, number of exacerbations, and costs during follow-up, controlling for patient characteristics.
A total of 24,770 patients were included: 7577 prompt, 9676 delayed, 7517 very delayed. Each 30-day delay of triple therapy was associated with 11% and 7% increases in the odds of any exacerbation and a severe exacerbation, respectively (odds ratio [95% CI]: 1.11 [1.10-1.13] and 1.07 [1.05-1.08]), a 4.3% (95% CI: 3.9-4.6%) increase in the number of exacerbations, a 1.8% (95% CI: 1.3-2.3%) increase in all-cause costs, and a 2.1% (95% CI: 1.6-2.6%) increase in COPD-related costs during follow-up.
Promptly initiating triple therapy after two moderate or one severe exacerbation is associated with decreased morbidity and economic burden in COPD. Proactive disease management may be warranted to prevent future exacerbations and lower costs among patients with COPD.
慢性阻塞性肺疾病（COPD）患者可能会经历中度（需要门诊治疗）或重度（需要住院治疗）疾病加重。指南建议，在一年内发生两次中度或一次重度加重后，将双药治疗（吸入皮质类固醇+长效β激动剂+长效抗胆碱能药物）升级为三联治疗。本研究旨在考察与加重后延迟/非常延迟启动三联治疗相比，早期启动三联治疗是否能降低未来加重的风险并降低医疗保健成本。
这是一项在美国医疗保健索赔中进行的回顾性观察性研究，纳入了在过去一年中至少发生两次中度或一次重度加重后，于 2011 年 1 月 1 日至 2020 年 3 月 31 日期间开始接受三联治疗（ICS/LABA/LAMA）的≥40 岁的 COPD 患者。第二次中度或第一次重度加重中最早的一次作为指数日期。根据三联治疗启动时间将患者分层：即刻（≤30 天）、延迟（31-180 天）、非常延迟（181-365 天）。在索引后 12 个月（随访）内评估 COPD 加重、全因和 COPD 相关医疗保健利用和成本。多变量回归估计了三联治疗每延迟 30 天对加重的可能性、加重次数和随访期间成本的影响，同时控制了患者特征。
共纳入 24770 例患者：7577 例即刻，9676 例延迟，7517 例非常延迟。三联治疗每延迟 30 天，任何加重和重度加重的可能性分别增加 11%和 7%（比值比[95%置信区间]：1.11[1.10-1.13]和 1.07[1.05-1.08]），加重次数增加 4.3%（95%置信区间：3.9-4.6%），全因费用增加 1.8%（95%置信区间：1.3-2.3%），COPD 相关费用增加 2.1%（95%置信区间：1.6-2.6%）。
在两次中度或一次重度加重后即刻启动三联治疗与 COPD 患者的发病率和经济负担降低相关。可能需要积极的疾病管理来预防未来的加重并降低 COPD 患者的成本。
