Real-World Disease Burden and Healthcare Resource Utilization Among Patients with COPD and Asthma Using Triple Therapy (FF/UMEC/VI) in the United States

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) and asthma are associated with chronic inflammation of the respiratory tract; despite some overlap of symptoms, they are considered separate disorders. Triple therapy is recommended for patients with COPD and asthma whose symptoms remain uncontrolled despite dual therapy. There are limited real-world studies evaluating outcomes among patients with COPD and asthma who are receiving inhaled triple therapy. This United States (US)-based real-world study aimed to evaluate clinical and economic outcomes among patients with COPD and asthma receiving single-inhaler triple therapy (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI]).
Patients and Methods: Retrospective pre-post study using claims data from the Optum Clinformatics^® database. Patients with COPD and asthma were indexed on the first date of FF/UMEC/VI prescription (1 October 2017– 31 March 2019). Each patient acted as their own control. Patients were required to have continuous health plan enrollment for 12 months prior to (pre-treatment) and following (post-treatment) index. Exacerbations, all-cause and COPD-related healthcare resource utilization, and costs were compared before and after FF/UMEC/VI initiation.
Results: Overall, 2743 patients were included (mean age: 71 years; 64% female). Cardiovascular disease was the most prevalent comorbidity during both the pre- and post-treatment periods (90% for both periods). There was a lower proportion of patients with ≥ 1 COPD exacerbation or ≥ 1 asthma exacerbation post-treatment versus pre-treatment (51% vs 57%, p< 0.0001, and 22% vs 32%, p< 0.0001, respectively). Fewer patients had ≥ 1 all-cause office visit post-treatment versus pre-treatment (99.3% vs 99.7%, p=0.0329); more patients had ≥ 1 COPD-related office visit post-treatment versus pre-treatment (89.6% vs 87.5%, p=0.0035). Total all-cause healthcare costs were significantly higher post-treatment versus pre-treatment (&dollar72,809 vs &dollar63,734, p< 0.0001). The driver of increased costs appeared to be primarily non-COPD-related (COPD-related costs: post-treatment &dollar27,779 vs pre-treatment &dollar25,081, p=0.0062).
Conclusion: FF/UMEC/VI reduced exacerbations among patients with COPD and asthma in a real-world setting in the US.

Plain Language Summary: Chronic obstructive pulmonary disease (COPD) and asthma are different respiratory conditions that have similar symptoms. Patients can be diagnosed with both conditions at the same time. A flare-up of COPD or asthma symptoms can lead to a lung attack, which can result in hospitalization and a considerable decline in patient health as well as being associated with high healthcare resource use and costs.
An inhaler with three different medicines (fluticasone furoate, umeclidinium, and vilanterol; shortened to FF/UMEC/VI) can be prescribed for patients with COPD or asthma. This study was done to assess how FF/UMEC/VI (taken using a single inhaler) affected lung attacks as well as healthcare resource use and costs among patients who have been diagnosed with both COPD and asthma.
This study found that fewer patients experienced a lung attack in the first 12 months after starting FF/UMEC/VI compared with the 12 months before starting FF/UMEC/VI. A lower proportion of patients had ≥ 1 medical office visit, ≥ 1 hospital admission, or ≥ 1 emergency room visit after starting FF/UMEC/VI compared with before FF/UMEC/VI. Many patients in this study had other medical conditions such as heart and kidney disease as well as their asthma and COPD. Although total healthcare costs were higher for patients after they had started FF/UMEC/VI compared with before, this appeared to be mainly due to patients’ other medical conditions, besides from COPD.
FF/UMEC/VI may be able to reduce future symptom flare-ups and lung attacks in patients who have been diagnosed with both COPD and asthma.

Keywords: asthma, chronic obstructive pulmonary disease, exacerbation, HCRU, real-world, triple therapy