Real-World Evidence of the Effectiveness of Inhaled Corticosteroid-Containing Therapies in Reducing Exacerbations and Medical Costs in COPD

Speaker(s)

Siddharthan T1, Lamprey C2, Aggarwal K3, Pan Y4, Tejwani V5
1University of Miami, Miami, FL, USA, 2Verona Pharma, Inc., Morrisville, NC, USA, 3Verona Pharma, Inc., Raleigh, NC, USA, 4Stratevi LLC, Santa Monica, CA, USA, 5Cleveland Clinic, Cleveland, OH, USA

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a burdensome chronic condition, accompanied by substantial healthcare costs often driven by exacerbations. One goal of COPD maintenance treatment, particularly those containing inhaled corticosteroids (ICS), is preventing exacerbations. This study aims to assess exacerbations and related costs with common ICS-containing maintenance regimens [long-acting beta2-agonist/inhaled corticosteroid (LABA/ICS) or long-acting muscarinic antagonist (LAMA), LABA, and ICS (LAMA/LABA/ICS)].

METHODS: A retrospective cohort study of Optum’s Clinformatics Datamart identified COPD patients ≥40 years old who initiated new maintenance therapy with LABA/ICS or LAMA/LABA/ICS (single inhaler) between January 2016 and June 2023. The index date was the first COPD maintenance therapy prescription claim. Patients had 12 months of continuous enrollment pre- and post-index. Moderate and severe COPD exacerbations in the pre- and post-index were assessed, along with annualized exacerbation-related costs.

RESULTS: 137,691 patients were included. 66,493 (48.3%) patients started LABA/ICS and 12,482 (9.1%) started LAMA/LABA/ICS. For patients on LABA/ICS, moderate and severe exacerbations occurred in the pre-index period in 38.1% and 14.0%, respectively, and in the post-index period in 31.7% and 9.6%, respectively (both p<0.001). For patients on LAMA/LABA/ICS, moderate and severe exacerbations occurred in the pre-index period in 38.4% and 11.5%, respectively, and in post-index period in 35.6% and 8.7%, respectively (both p<0.001). Total medical exacerbation-related costs for LABA/ICS (mean (SD)) were $4170 (23400) pre-index and $3870 (21400) post-index (p=0.010), and for LAMA/LABA/ICS were $3540 (15400) pre-index and $3660 (16100) post-index (p=0.516). Costs of antibiotics and oral corticosteroid prescriptions (mean (SD)) were $30.0 (81.8) pre-index and $26.7 (97.5) post-index with LABA/ICS (p<0.001), and $26.8 (60.2) pre-index and $28.3 (177) post-index with LAMA/LABA/ICS (p=0.323).

CONCLUSIONS: While common ICS-containing COPD maintenance treatments are effective at reducing exacerbations, there remains a substantial burden of healthcare cost associated with exacerbations, as demonstrated by the medical cost post-index.

Code

CO53

Topic

Clinical Outcomes, Economic Evaluation, Study Approaches

Topic Subcategory

Clinical Outcomes Assessment

Disease

Drugs, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)