Dual versus triple therapy in patients hospitalized for COPD in France: a claims data study

Abstract

Purposes

Following a hospitalization for COPD, dual and triple therapies were compared in terms of persistence and relations with outcomes (exacerbations, health care resource use and costs).

Methods

This was a historical observational database study. All patients aged ≥45 hospitalized for COPD between 2007 and 2015 were identified in a 1/97^th random sample of French claims data. Patients receiving dual therapy within 60 days after hospitalization were compared to patients receiving triple therapy, after propensity score matching on disease severity.

Results

Of the 3,089 patients hospitalized for COPD, 1,538 (49.8%) received either dual or triple therapy in the 2 months following inclusion, and 1,500 (48.6%) had at least 30 days of follow-up available; 846 (27.4%) received dual therapy, and 654 (21.2%) received triple therapy. After matching, the number of exacerbations was 2.4 per year in the dual vs 2.3 in the triple group (p=0.45). Among newly treated patients (n=206), persistence at 12 months was similar in the dual and triple groups (48% vs 41%, respectively, p=0.37). As compared to patients on dual therapy, more patients on triple therapy received oral corticosteroids (49.1 vs 40.4%, p=0.003) or were hospitalized for any reason (67% vs 55.8%, p=0.0001) or for COPD (35.3 vs 25.1%, p=0.0002) during follow-up. Cost of care was higher for patients on triple than for those on dual therapy (€11,877.1 vs €9,825.1, p=0.01).

Conclusion

Following hospitalizations for COPD, patients on dual and triple therapy experienced recurrent exacerbations, limited adherence to therapies and high cost of care. Patients on triple therapy appeared more severe than those on dual therapy, as reflected by exacerbations and health care resource use.

Keywords:

• COPD
• therapy
• persistence
• exacerbations
• health care resource use

Supplementary materials

Table S1 Characteristics of non-matched patients and matched patients on dual or triple therapy

Table S2 Sensitivity analysis: percentage of non-persistent patients at 12 months after index date, where non-persistence was defined as a treatment discontinuation of at least 61 instead of 91 consecutive days

Acknowledgments

We thank the French National Health Service (Caisse Nationale de l’Assurance Maladie) and the National Institute of Health Data (Institut National des Données de Santé) for providing data. The study was funded by Chiesi SAS.

Abbreviations

EGB, Echantillon Généraliste des Bénéficiaires; FDC, fixed-dose combination; GP, general practitioner; HRU, health care resource use; ICD-10, International Classification of Diseases 10th Version; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; LTD, long-term disease; NIV, non-invasive ventilation; NS, non-significant; OCS, oral corticosteroids; PMSI, programme de médicalisation des systèmes d’information (French Diagnosis Related Group-based medical information system); PFT, pulmonary function testing; SABA, short-acting beta-agonist; SAMA, short-acting muscarinic antagonist.

Disclosure

EVG is Scientific Advisor of PELyon, he reports personal fees from PELyon, during the conduct of the study; personal fees from PELyon, outside the submitted work. MN, FD and MB (employees of PELyon) conducted the study through sponsorship by Chiesi SAS, and were not paid for manuscript development. NR reports grants and personal fees from Boehringer Ingelheim, Novartis, Pfizer and personal fees from Teva, GSK, AstraZeneca, Mundipharma, Cipla, Sanofi, Sandoz, 3M, Zambon and Chiesi. PD has received consulting fees, honoraria for lectures and/or research funding from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, and Novartis during the last 3 years. He reports personal fees from Chiesi, during the conduct of the study; personal fees from Astra Zeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GlaxoSmithKline, personal fees from Novartis, personal fees from Sanofi, outside the submitted work. BH received honorarium from Boehringer Ingelheim, Pfizer, Novartis, Teva, GSK, AstraZeneca and Chiesi for his participation in scientific committees or conferences. He reports personal fees from Chiesi, during the conduct of the study; personal fees from GSK, personal fees from Boehringer Ingelheim, personal fees from Novartis, outside the submitted work. HP received honorarium from Boehringer Ingelheim, Novartis, Teva, GSK, AstraZeneca and Chiesi for his participation in scientific committees or conferences, is on the board for Chiesi and Novartis, and received an invitation to 2019 American Thoracic Society International Conference in Arizona, USA.  GD received research funding from BTG/PneumRx and received honorarium from Boehringer Ingelheim, AstraZeneca, Chiesi, Novartis, BTG/PneumRx for his participation in scientific committees or conferences. He reports personal fees from Chiesi, during the conduct of the study; personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from BTG/PneumRx, and personal fees from Nuvaira, outside the submitted work. The authors report no other conflicts of interest in this work.