Inpatient Admissions and Re-Admissions in Medicare Beneficiaries Initiating Umeclidinium/Vilanterol or Tiotropium Therapy

Abstract

Purpose: Patients with chronic obstructive pulmonary disease (COPD) who are hospitalized are more likely to die from their illness and have increased likelihood of re-admission than those who are not. Subsequent re-admissions further increase the burden on healthcare systems. This study compared inpatient admission rates and time-to-first COPD-related inpatient admission among Medicare beneficiaries with COPD indexed on umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO).
Patients and Methods: This retrospective study used the All-Payer Claims Database to investigate hospital admission and re-admission outcomes in Medicare beneficiaries with COPD with an initial pharmacy claim for UMEC/VI or TIO from 1 January 2015 to 28 February 2020. Inpatient admissions, baseline, and follow-up variables were assessed in patients indexed on UMEC/VI and TIO after propensity score matching (PSM), with time-to-first on-treatment COPD-related inpatient admission as the primary endpoint. Re-admissions were assessed among patients with a COPD-related inpatient admission in the 30- and 90-days post-discharge.
Results: Post-PSM, 7152 patients indexed on UMEC/VI and 7069 on TIO were eligible for admissions analysis. The mean (standard deviation [SD]) time-to-first COPD-related inpatient admission was 46.71 (87.99) days for patients indexed on UMEC/VI and 44.96 (85.90) days for those on TIO (p=0.06). The mean (SD) number of inpatient admissions per patient was 1.24 (2.92) for patients indexed on UMEC/VI and 1.26 (3.05) for those on TIO (p=0.49). Proportion of patients undergoing re-admissions was similar between treatments over both 30 and 90 days, excluding a significantly lower proportion of patients indexed on UMEC/VI than those indexed on TIO for COPD-related re-admissions for hospital stays of 4– 7 days and 7– 14 days, and all-cause re-admissions for stays of 4– 7 days.
Conclusion: Patients with COPD using Medicare in the US and receiving UMEC/VI or TIO reported similar time-to-first inpatient admission and similar proportion of re-admissions.

Plain Language Summary: Umeclidinium/vilanterol (UMEC/VI) is associated with improvements in patient outcomes for chronic obstructive pulmonary disease (COPD) versus tiotropium (TIO). Patients with COPD who have hospitalizations have higher healthcare costs and are more likely to be re-hospitalized and die from their illness than those who do not. This study compared hospital admission rates and time to admission among Medicare beneficiaries with COPD treated with UMEC/VI versus TIO.
This study used a medical record database to compare hospital admissions and re-admissions, baseline and follow-up variables were compared in patients prescribed with UMEC/VI and TIO from 1 January 2015 to 28 February 2020. Hospital re-admissions were assessed among patients with a COPD-related inpatient admission in the 30 or 90 days after discharge.
Patients had similar COPD-related hospitalizations and number of hospital admissions per patient regardless of medication. Proportion of patients undergoing re-admissions was similar between treatments, apart from a lower proportion of patients prescribed UMEC/VI than TIO for COPD-related re-admissions for hospital stays of 4– 7 and 7– 14 days, and all-cause re-admissions for 4– 7 days.
Despite expectations that patients receiving UMEC/VI would demonstrate increased time-to-first admission and a lower proportion of re-admissions than those receiving TIO, patients reported similar data irrespective of their prescribed medication. Use of head-to-head comparison with claims data and inability to divide patients based on lung function or clinical symptoms may have decreased chances of detecting any significant difference between the treatments, although these results support current recommendations on use of dual therapy.

Keywords: COPD, initial maintenance therapy, umeclidinium/vilanterol dual therapy, tiotropium monotherapy, hospital admissions, hospital re-admissions