Benefit of Prompt versus Delayed Use of Single-Inhaler Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Following a COPD Exacerbation

Abstract

David Mannino,1 Michael Bogart,2 Guillaume Germain,3 Shirley P Huang,2 Afisi S Ismaila,4,5 François Laliberté,3 Young Jung,3 Sean D MacKnight,3 Marjorie A Stiegler,6,7 Mei Sheng Duh8 1Department of Medicine, University of Kentucky, Lexington, KY, USA; 2GlaxoSmithKline, Value Evidence and Outcomes, Research Triangle Park, NC, USA; 3Groupe d’analyse, Ltée, Montréal, QC, Canada; 4GlaxoSmithKline, Value Evidence and Outcomes, Collegeville, PA, USA; 5Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; 6GlaxoSmithKline, Medical Affairs, Research Triangle Park, NC, USA; 7Department of Anesthesiology and Critical Care, University of North Carolina, Chapel Hill, NC, USA; 8Analysis Group, Boston, MA, USACorrespondence: Michael Bogart, GlaxoSmithKline, Value Evidence and Outcomes, 5 Moore Drive, PO Box 13398, Research Triangle Park, NC, 27709-3398, USA, Tel [phone], Email [email protected]: Triple therapy (TT; inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β2-agonist) is recommended for patients with chronic obstructive pulmonary disease (COPD) at risk of exacerbation, although the optimum timing of TT initiation remains unclear. This study evaluated the impact of prompt versus delayed initiation of single-inhaler TT (fluticasone furoate, umeclidinium, and vilanterol [FF/UMEC/VI]) following a COPD exacerbation.Patients and Methods: This retrospective cohort study used data from the IQVIA PharMetrics® Plus database. Patients initiating FF/UMEC/VI following a COPD exacerbation between September 18, 2017 and September 30, 2019 (exacerbation = index date) were categorized as prompt (within 30 days of index) or delayed (31– 180 days after index) FF/UMEC/VI initiators. Patients were aged ≥ 40 years at index, had ≥ 12 months’ continuous health insurance coverage before index (baseline), and ≥ 6 months’ coverage after index (follow-up). Patients with a COPD exacerbation or claim for FF/UMEC/VI during baseline were excluded. Inverse probability weighting was used to adjust for differences in baseline characteristics between cohorts. Exacerbations (overall, moderate, and severe), healthcare costs, and readmissions were evaluated during follow-up.Results: A total of 1904 patients (prompt: 529; delayed: 1375) were included. After weighting, baseline characteristics were well balanced between cohorts. Patients in the prompt cohort had significantly lower rates per person-year (PPY) of overall (0.98 vs 1.23; rate ratio [RR] [95% CI] = 0.79 [0.65– 0.94], p = 0.004), moderate (0.86 vs 1.03; RR [95% CI] = 0.84 [0.69– 0.99], p = 0.038), and severe (0.11 vs 0.20; RR [95% CI] = 0.57 [0.37– 0.79], p = 0.002) exacerbations, compared with delayed initiators. Mean all-cause and COPD-related healthcare costs were significantly lower among prompt initiators (all-cause: $26,107 vs $32,400 PPY, p = 0.014; COPD-related: $12,694 vs $17,640 PPY, p = 0.002).Conclusion: Prompt initiation of FF/UMEC/VI following a moderate or severe COPD exacerbation was associated with significant reductions in exacerbations and healthcare costs relative to delayed initiation.Keywords: chronic obstructive pulmonary disease, exacerbation, healthcare cost, single-inhaler triple therapy

Keywords

• chronic obstructive pulmonary disease
• exacerbation
• healthcare cost
• single-inhaler triple therapy.