Reducing Healthcare Costs and Addressing Health Equity Through Improved Treatment Adherence and Reduced Exacerbation Risk in Chronic Obstructive Pulmonary Disease: Real-World Evidence From a Danish Nationwide Cohort Study
Author(s)
Nicolai Krogh, PhD1, Anne Cathrine Falch-Jørgensen, PhD2, Louise Dalsager, PhD2, Yunus Çolak, PhD3.
1Chiesi Pharma AB, Søborg, Denmark, 2Signum Life Science, Copenhagen, Denmark, 3Department of Respiratory Medicine and the Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
1Chiesi Pharma AB, Søborg, Denmark, 2Signum Life Science, Copenhagen, Denmark, 3Department of Respiratory Medicine and the Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) imposes a substantial economic burden on healthcare systems worldwide, primarily driven by severe exacerbations requiring hospital admission. Improving treatment adherence and preventing hospital admission, are essential to reduce the health economic burden of COPD. Despite treatment guidelines recommending simplified inhaler regimens, multiple inhaler triple therapy (MITT) as opposed to single inhaler triple therapy (SITT) remains common. Objectives: To investigate real-world prescription patterns, treatment adherence, exacerbation rates, health equity, and healthcare cost implications of SITT compared to MITT in COPD management.
METHODS: We conducted a Danish nationwide registry study including 45,000 patients with COPD on triple inhaler therapy between 2016 and 2022. Treatment adherence was assessed using Proportion of Days Covered (PDC). Exacerbations were defined as mild to moderate (requiring only OCS use) and severe (leading to COPD-related hospital admission).
RESULTS:
CONCLUSIONS: This large-scale real-world nationwide cohort study demonstrates that SITT compared to MITT improves treatment adherence, reduces exacerbations, and helps to reduce health inequities by simplifying inhaler regimens in the management of COPD. Widespread adoption of SITT over MITT represents a scalable, cost-saving strategy to improve both patient outcomes and healthcare system efficiency.
METHODS: We conducted a Danish nationwide registry study including 45,000 patients with COPD on triple inhaler therapy between 2016 and 2022. Treatment adherence was assessed using Proportion of Days Covered (PDC). Exacerbations were defined as mild to moderate (requiring only OCS use) and severe (leading to COPD-related hospital admission).
RESULTS:
- SITT prescriptions increased rapidly following its introduction in 2017, comprising 80% of new triple therapy initiations by 2022.
- Patients with lower income were overrepresented among MITT vs SITT users (29% vs 20%), highlighting a health equity gap.
- Treatment adherence was significantly higher with SITT compared to MITT during the first 180 days (PDC: 93% vs 78%) and remained consistently higher over two years (PDC: 79% vs 49%).
- SITT compared to MITT users experienced a 4% reduction in any exacerbations and 11% reduction in hospital admission after adjusting for confounders.
- Economic modelling indicates that the reduction in hospital admissions with SITT may yield substantial cost savings, owing to the disproportionate cost of inpatient versus outpatient care.
CONCLUSIONS: This large-scale real-world nationwide cohort study demonstrates that SITT compared to MITT improves treatment adherence, reduces exacerbations, and helps to reduce health inequities by simplifying inhaler regimens in the management of COPD. Widespread adoption of SITT over MITT represents a scalable, cost-saving strategy to improve both patient outcomes and healthcare system efficiency.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO210
Topic
Clinical Outcomes, Economic Evaluation, Study Approaches
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)