BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) affected 251 million people and caused 5% of deaths worldwide in 2016. GOLD recommends long-acting muscarinic antagonists/beta₂-agonists (LAMA+LABA) as next-in-line therapy for symptomatic COPD patients on mono-maintenance therapy; ultimately escalating to TT (LAMA+LABA+inhaled corticosteroids) upon further exacerbations and post-risk/benefit (e.g., pneumonia) assessment.

OBJECTIVES: Compare COPD-related, non-COPD pneumonia-related, and all-cause HCRU among TIO+OLO (a fixed-dose LAMA+LABA inhaler) vs. TT initiators, in a U.S. Medicare Advantage population with COPD stratified by baseline exacerbation history (surrogate measure for disease severity): none=0 (subgroup N=737); single=1 moderate (N=275); multiple/severe=≥2 moderate or ≥1 severe exacerbation[s] (N=228).

METHODS: This retrospective observational post-hoc analysis involved COPD patients ≥40 initiating TIO+OLO or TT between 01Jan2014-31Mar2018. 12 months pre-index and ≥30 days post-index continuous medical/pharmacy coverage was required. Patients were propensity score matched 1:1. Annualized population averages were estimated.

RESULTS: Among patients with no exacerbation history, TIO+OLO had significantly lower COPD-related mean inpatient (0.20 vs. 0.49) and length of stay (1.18 vs. 3.46 days), ambulatory (5.01 vs. 6.78; all p<0.001) and emergency room (ER; 0.24 vs. 0.42; p<0.05) visits. Non-COPD pneumonia-related mean inpatient (0.05 vs. 0.15; p=0.007) and ER (0.04 vs. 0.09; p=0.036) visits were lower. All-cause HCRU was significantly lower across all settings. Among single, multiple/severe subgroups, TIO+OLO had lower COPD-related ambulatory (6.90 vs. 9.92; 8.96 vs. 13.22 respectively; all p≤0.003) and other medical (3.35 vs. 5.88; 6.87 vs. 10.01 respectively; all p<0.015) visits.

CONCLUSIONS: From a HCRU perspective, these real-world findings question the value of prescribing TT across all COPD severities.