Cost burden in COPD patients initiating ICS vs. non-ICS maintenance regimens

Abstract

Background: 2019 GOLD recommendations recognize LAMA/LABA mono/dual therapy as the foundation of COPD maintenance therapy, reserving ICS-containing regimens only after assessing risk/benefit due to possible AEs (e.g., pneumonia). Yet, evidence suggests GOLD inconsistent prescribing practices of ICS containing therapies across all COPD severities potentially lead to substantial unnecessary, avoidable burden. Aim: Assess COPD- and COPD/pneumonia-related differences in pre-post annual cost burden among patients initiating ICS vs. non-ICS maintenance regimens in a real-world, U.S. Medicare-advantage Part D prescription coverage population. Methods: This was a retrospective observational study of 40+ aged COPD patients initiating an ICS (LABA/ICS or LAMA/LABA/ICS) or non-ICS regimen (LAMA or LAMA/LABA) between 1/1/14-6/30/16, with ≥12 months of pre- and post-index medical and pharmacy continuous eligibility in the Optum® Research Database. Index date was start of ≥30 consecutive days of first treatment regimen (mutually exclusive). Pre- and post-index 12-month COPD- and COPD/pneumonia-related health-plan paid total (medical+pharmacy) cost differences (Δ) per cohort were calculated. Results: ICS (N=11,348) and non-ICS (N=6,633) cohorts had similar demographic and comorbidity burden. Total annual COPD-related pre-post cost Δ for ICS vs. non-ICS cohorts were $3,749±325 and $3,624±336 respectively. Accounting for pneumonia increased them to $4,013±529 and $3,643±570 respectively. The between-cohort Δ were not statistically significant. Conclusion: There was a small increase in post-initiation COPD burden for ICS vs. non-ICS patients ($125/patient) that becomes numerically larger when accounting for pneumonia ($370).