OBJECTIVES

Multiple or single inhaler triple therapy (MITT, SITT) comprising ICS+LABA+LAMA is used for asthma and COPD. Algorithms to identify MITT use in real-world databases were developed for COPD patients and may not be appropriate for asthma patients (who should use two inhalers, a fixed combination of ICS-LABA, plus LAMA). We explored key algorithm assumptions by making small changes to these and observing the impact on estimates of MITT prevalence and MITT adherence.

METHODS

Ten algorithms for MITT were developed and applied to an asthma cohort in the IBM MarketScan claims database to explore key assumptions on components, overlap, and discontinuation gap: A, A2, A3, A4 (requiring ICS-LABA+LAMA); B, B2, B3 (requiring ICS-LABA+Tiotropium, dispensed on same day); C, C2, C3 (any combination of ICS, ICS-LABA, LAMA, LAMA-LABA, LABA that constitutes MITT). The cohort included asthma-diagnosed adults with data available July2018-June2019; COPD-diagnosed patients were excluded. Prevalence (≥1day MITT use during the year) and adherence (proportion days covered with MITT during the year ≥50%) were compared between algorithms where there was a single change in assumption.

RESULTS

The algorithms produced different estimates of MITT use in our cohort (N=258,373; prevalence range: 0.53%-1.88%; adherence range: 13.2%-35.9%). Requiring dispensing of MITT components on the same day significantly decreased prevalence (A3_0.68%, A4_1.69%) and adherence (A3_12.9%, A4_30.0%). Increasing the required days overlap of MITT components from ≥1day to ≥14days had negligible impact on prevalence (A_1.72%, A2_1.69%) and adherence (A_25.8%, A2_24.9%). Halving the discontinuation gap from >90days to >45days did not impact prevalence (B_0.53%, B2_0.53%), but slightly decreased adherence (B_15.5%, B2_13.2%). Allowing all combinations of ICS+LABA+LAMA vs only ICS-LABA+LAMA slightly increased prevalence (C3_1.88%, A_1.72%) and considerably increased adherence (C3_35.9%, A_25.9%).

CONCLUSIONS

MITT algorithms developed for COPD may not be applicable to asthma; sensitivity analyses should always be conducted to explore the uncertainty on key assumptions.

Funding: GSK_Study_207017