OBJECTIVES: To estimate the potential cost savings and reduction in exacerbations by following guideline recommendations in subjects being treated for COPD with the combination of LABA, LAMA or ICS. METHODS: Subjects were identified with a diagnosis for COPD using ICD-9 codes between January 1, 2004 to December 31, 2007. The index date was based on first prescription of a LAMA+LABA, LAMA+LABA/ICS, or LABA+ICS. Based on pulmonary function test (PFT) data within 30 days of the index date, subjects were classified as adhering or nonadhering to guidelines. Chi-square and t-test were conducted to determine the differences among cohorts. RESULTS: A total of 365 subjects were identified as adhering or non-adherent to guidelines based on their PFT data. Oxygen were significantly higher in LAMA plus LABA/ICS and lower in LABA/ICS as compared to LAMA plus LABA cohort (p<0.05). Also, number of office visits and hospital admissions were significantly higher in LAMA plus LABA/ICS compared to LAMA plus LABA cohort. The mean number of prescriptions for antibiotics and prednisone was higher in LAMA plus LABA/ICS cohort. The highest mean number of baseline exacerbations was observed in LAMA plus LABA/ICS group (12.9) with 6.06 in LABA plus ICS group and 7.76 in LAMA plus LABA group. 31% of the subgroup received COPD medications consistent with guidelines was associated with cost savings of $5,889 for LAMA plus LABA, $3,330 for LABA+ICS, and $10,217 for LAMA plus LABA/ ICS cohorts. The LAMA plus LABA (1.3 vs. 2.9) LABA plus ICS (2.78 vs. 3.57), and LAMA plus LABA/ICS (-0.82 vs. 3.62) cohorts had lower mean change in exacerbations in adhering group versus non-adhering group. CONCLUSIONS: Adherence to current GOLD guidelines is associated with lower costs and fewer exacerbations in subjects with moderate to severe COPD for LAMA plus LABA, LABA plus ICS and LAMA plus LABA/ICS groups.
Asche, C., Leader, S., Plauschinat, C., Raparla, S., Ye, X., Yan, M., & Young, D. (2011). PRS28 Adherence to Current Guidelines for Chronic Obstructive Pulmonary Disease (COPD) in Subjects Treated with Combination of Long-Acting β2-Agonist (LABA), LONG-Acting Muscarinic Antagonist (LAMA) or Inhaled Corticosteroids (ICS). Value in Health, 14(7), A492. https://doi.org/10.1016/j.jval.2011.08.1415