International Journal of COPD (Oct 2021)
Quantifying the Economic Impact of Delayed Multiple-Inhaler Triple Therapy Initiation in Patients with COPD: A Retrospective Cohort Study of Linked Electronic Medical Record and Hospital Administrative Data in England
Abstract
Leah B Sansbury,1 Robert P Wood,2 Glenn A Anley,3 Yein Nam,2 Afisi S Ismaila4,5 1Epidemiology, Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 2Observational Research, Adelphi Real World, Bollington, UK; 3UK Health Outcomes, GlaxoSmithKline, Uxbridge, UK; 4Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA; 5Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Afisi S IsmailaValue Evidence and Outcomes, GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, PA, 19426-0989, USATel +1 919 315 8229Email [email protected]: 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).Patients and Methods: 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.Results: 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).Conclusion: 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.Keywords: chronic obstructive pulmonary disease, England, exacerbation, healthcare utilization, multiple-inhaler triple therapy, triple therapy
