Purpose: To compare, in commercially-insured individuals ≥40 years old, the risk of chronic obstructive pulmonary disease (COPD) exacerbations and COPD-related health care utilization and costs in patients initiating maintenance treatment with fluticasone propionate/salmeterol xinafoate 250 μg/50 μg (FSC) with those in patients initiating treatment with tiotropium bromide (TIO)
Design: Retrospective observational cohort study
Methodology: The risk of COPD exacerbation (moderate, severe, and any), COPD-related health care utilization, and COPD-related costs (overall and by service setting) were assessed over 12 months after the initiation of treatment with FSC or TIO in commercially-insured patients ≥40 years old diagnosed with COPD.
Principal findings: After adjusting for covariates, treatment with FSC compared with treatment with TIO was associated with a 14% reduction in risk of severe exacerbation (p=0.0406), defined as the occurrence of a COPD-related hospitalization; with less health care utilization across several categories of care; with 25% lower COPD-related medical costs ($1,814 versus $2,258 per patient, p<0.0001); and with 10% lower COPD-related total costs ($2,991 versus $3,304 per patient, p<0.0001) over a 12-month follow-up period. Pharmacy costs were equivalent between FSC and TIO.
Conclusion: Initiation of maintenance therapy with FSC compared with TIO was associated with significant reductions in the risk of severe exacerbations, health care utilization, and COPD-related medical and total costs. Considered in the context of other findings, these data suggest that earlier maintenance treatment with FSC offers clinical and economic benefits over maintenance treatment with TIO.
Key words: chronic obstructive pulmonary disease (COPD), fluticasone/salmeterol xinafoate, tiotropium, bronchodilator, corticosteroid, cost, pharmacoeconomics