Value Evidence and Outcomes, Epidemiology, GSK, R&D Global Medical, Brentford, Middlesex, UK.
Real-world Evidence, Adelphi Real World, Bollington, Cheshire, UK.
Int J Chron Obstruct Pulmon Dis. 2022 Aug 10;17:1781-1795. doi: 10.2147/COPD.S365480. eCollection 2022.
Treatment pathways of patients with chronic obstructive pulmonary disease (COPD) receiving single-inhaler dual therapies remain unclear. We aimed to describe characteristics, prescribed treatments, healthcare resource use (HCRU) and costs of patients with COPD who initiated single-inhaler long-acting muscarinic antagonist/long-acting β-agonist (LAMA/LABA) dual therapy in primary care in England.
Retrospective study using linked data from Clinical Practice Research Datalink Aurum and Hospital Episode Statistics datasets. Patients with COPD with ≥1 single-inhaler LAMA/LABA prescription between June 2015 and December 2018 (index) were included. Demographic and clinical characteristics, prescribed treatments, HCRU and costs were evaluated in the 12 months pre-index. Data are presented for patients not receiving concomitant inhaled corticosteroids at index (non-triple users).
Of 10,991 patients initiating LAMA/LABA, 9888 were non-triple users, of whom 21.3% (n=2109) received aclidinium bromide/formoterol, 18.1% (n=1785) received indacaterol/glycopyrronium, 12.0% (n=1189) received tiotropium bromide/olodaterol and 48.6% (n=4805) received umeclidinium/vilanterol. Demographic and clinical characteristics were similar across indexed therapies. LAMA monotherapy was the most frequently prescribed respiratory therapy at 12 (18.4-25.8% of patients) and 3 months (23.9-33.7% of patients) pre-index across indexed therapies; 42.5-59.0% of patients were prescribed no respiratory therapy at these time points. COPD-related HCRU during the 12 months pre-index was similar across indexed therapies (general practitioner consultations: 62.0-68.6% patients; inpatient stays: 19.3-26.1% patients). Pre-index COPD-related costs were similar across indexed therapies, with inpatient stays representing the highest contribution. Mean total direct annual COPD-related costs ranged from £805-£1187.
Characteristics of patients newly initiating single-inhaler LAMA/LABA dual therapy were highly consistent across indexed therapies. As half of non-triple users were not receiving respiratory therapy one year prior to LAMA/LABA initiation, there may be an opportunity for early optimization of treatment to relieve clinical burden versus current prescribing patterns in primary care in England.
接受单吸入器双重治疗的慢性阻塞性肺疾病（COPD）患者的治疗途径仍不清楚。我们旨在描述在英格兰初级保健中开始使用单吸入器长效毒蕈碱拮抗剂/长效β-激动剂（LAMA/LABA）双重治疗的 COPD 患者的特征、规定的治疗方法、医疗保健资源使用（HCRU）和成本。
使用来自临床实践研究数据链接 Aurum 和医院发病统计数据集的链接数据进行回顾性研究。纳入 2015 年 6 月至 2018 年 12 月期间至少有一次单吸入器 LAMA/LABA 处方的 COPD 患者（索引）。在索引前 12 个月评估人口统计学和临床特征、规定的治疗方法、HCRU 和成本。数据适用于索引时未同时使用吸入性皮质类固醇的患者（非三联使用者）。
在开始使用 LAMA/LABA 的 10991 名患者中，9888 名患者为非三联使用者，其中 21.3%（n=2109）接受了溴化阿地溴铵/福莫特罗，18.1%（n=1785）接受了茚达特罗/格隆溴铵，12.0%（n=1189）接受了噻托溴铵/奥洛达特罗，48.6%（n=4805）接受了乌美溴铵/维兰特罗。各索引治疗的人口统计学和临床特征相似。在索引治疗中，LAMA 单药治疗在索引前 12 个月（18.4-25.8%的患者）和 3 个月（23.9-33.7%的患者）最常规定为呼吸治疗；在这些时间点，42.5-59.0%的患者未规定任何呼吸治疗。在索引前 12 个月期间，与 COPD 相关的 HCRU 在各索引治疗中相似（全科医生就诊：62.0-68.6%的患者；住院：19.3-26.1%的患者）。与 COPD 相关的索引前成本在各索引治疗中相似，住院治疗占比最高。每年与 COPD 相关的总直接费用中位数范围为 805-1187 英镑。
新开始使用单吸入器 LAMA/LABA 双重治疗的患者的特征在各索引治疗中高度一致。由于一半的非三联使用者在开始 LAMA/LABA 治疗前一年没有接受呼吸治疗，因此与目前在英格兰初级保健中的处方模式相比，可能有机会尽早优化治疗以减轻临床负担。
