背景:因慢性阻塞性肺疾病(COPD)加重而住院的患者有再次入院的风险,增加治疗费用,和超额死亡率。这项研究评估了接受米可地铵/维兰特罗(UMEC/VI)与噻托溴铵(TIO)初始维持治疗的患者的住院和再入院。
方法:本回顾性研究,配对队列研究确定了COPD患者,这些患者在2013年1月1日至2018年12月31日(指标日期定义为最早配药)期间,从Optum的去识别临床形式学数据集市数据库中,开始使用UMEC/VI或TIO进行维持治疗.合格标准包括:COPD预指数或指数日的≥1项医疗索赔;连续合格预指数≥12个月;指数年龄≥40岁;无指数前或指数后哮喘诊断;无含吸入性皮质类固醇药物的指数前索赔,长效β2-激动剂,或长效毒蕈碱拮抗剂.结果包括首次治疗COPD相关住院的时间,治疗中COPD相关入院率,30和90天内全因和COPD相关再入院率。倾向得分匹配用于调整潜在的混杂因素。
结果:匹配的UMEC/VI和TIO队列均包括7997例患者,基线特征平衡(平均年龄70.9岁;女性47.1-47.6%)。超过12个月,与TIO相比,开始进行UMEC/VI治疗的患者的COPD相关住院风险(风险比[95%CI]:0.87[0.79,0.96];p=0.006)和比率(比率比[95%CI]:0.80[0.72,0.92];p=0.008)显著降低.虽然全因再入院率在治疗队列之间相似,UMEC/VI与TIO相比,初次住院时间为1-3天的患者的再入院率在数值上较低(30天再入院:10.5%与12.4%;90天再入院:15.5%vs.19.8%)。COPD相关的再入院观察到类似的模式。
结论:这些发现强调了UMEC/VI与TIO双重治疗在减少COPD患者住院和再入院方面的实际益处。这可能会转化为更低的医疗成本。
住院的慢性阻塞性肺疾病(COPD)患者将来更有可能再次入院。有更高的医疗成本,更有可能死于疾病。再次入院的患者的治疗费用甚至更高。确定哪些治疗方法最适合减少住院COPD患者的数量,可能有助于改善预后并降低COPD治疗成本。我们使用美国医疗保健索赔数据来比较COPD的两种每日治疗方法,米可地铵/维兰特罗和噻托溴铵。我们的目的是找出哪种治疗方法在减少COPD住院方面更有效。我们还比较了每次治疗的患者在最初因COPD入院后30或90天内再次入院的人数。我们发现,与开始使用噻托溴铵治疗的患者相比,开始使用灭克地铵/维兰特罗治疗的患者因COPD入院的可能性较小。每次治疗的患者数量相似,在出院后30或90天内再次入院。然而,在初次住院时间短(1-3天)的患者中,与噻托溴铵相比,在30天或90天之内再入院的情况较少.这些发现表明,在减少需要入院或重新入院的COPD患者人数方面,灭克地铵/维兰特罗可能比噻托溴铵更有效。与噻托溴铵相比,开始使用灭克地铵/维兰特罗治疗COPD可能导致更好的健康结果和更低的成本。
BACKGROUND: Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are at risk of further readmissions, increased treatment costs, and excess mortality. This study evaluated inpatient admissions and readmissions in patients receiving initial maintenance therapy with umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO).
METHODS: This retrospective, matched cohort study identified patients with COPD who initiated maintenance therapy with UMEC/VI or TIO from Optum\'s de-identified Clinformatics Data Mart database between January 1, 2013, and December 31, 2018 (index date defined as earliest dispensing). Eligibility criteria included: ≥ 1 medical claim for COPD pre-index or on the index date; ≥ 12 months of continuous eligibility pre-index; age ≥ 40 years at index; no pre- or post-index asthma diagnosis; and no pre-index claims for medications containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists. Outcomes included time to first on-treatment COPD-related inpatient admission, rate of on-treatment COPD-related admissions, and rate of all-cause and COPD-related readmissions within 30 and 90 days. Propensity score matching was used to adjust for potential confounders.
RESULTS: Matched UMEC/VI and TIO cohorts each included 7997 patients and were balanced on baseline characteristics (mean age 70.9 years; female 47.1-47.6%). Over 12 months, patients initiating UMEC/VI had significantly reduced risk (hazard ratio [95% CI]: 0.87 [0.79, 0.96]; p = 0.006) and rates (rate ratio [95% CI]: 0.80 [0.72, 0.92]; p = 0.008) of COPD-related inpatient admissions compared with TIO. While all-cause readmission rates were similar between treatment cohorts, readmission rates among patients with an initial admission length of stay of 1-3 days were numerically lower for UMEC/VI versus TIO (30-day readmissions: 10.5% vs. 12.4%; 90-day readmissions: 15.5% vs. 19.8%). Similar patterns were observed for COPD-related readmissions.
CONCLUSIONS: These findings highlight the real-world benefits of dual therapy with UMEC/VI versus TIO in reducing inpatient admissions and readmissions in patients with COPD, which may translate to lower healthcare costs.
Patients with chronic obstructive pulmonary disease (COPD) who are admitted to the hospital are more likely to be readmitted in the future, have higher healthcare costs, and are more likely to die from their illness. Patients who are readmitted to hospital have even higher treatment costs. Identifying which treatments are best at reducing the number of patients with COPD who are admitted to the hospital may help to improve outcomes and reduce the cost of COPD treatment. We used US healthcare claims data to compare two daily treatments for COPD, umeclidinium/vilanterol and tiotropium. We aimed to find out which treatment was more effective at reducing hospital admissions due to COPD. We also compared how many patients on each treatment were readmitted within 30 or 90 days of their original hospital admission for COPD. We found that patients who started treatment with umeclidinium/vilanterol were less likely to be admitted to the hospital for COPD than patients who started treatment with tiotropium. Similar numbers of patients on each treatment were readmitted to the hospital within 30 or 90 days after they were discharged. However, among patients whose initial hospital stay was short (1–3 days), readmissions within 30 or 90 days were less common with umeclidinium/vilanterol than tiotropium. These findings suggest that umeclidinium/vilanterol may be more effective than tiotropium at reducing the number of patients with COPD who need to be admitted or readmitted to hospital. Starting COPD treatment with umeclidinium/vilanterol may lead to better health outcomes and lower costs than tiotropium.