Temporal Trends Of Pharmacologic Therapies For Patients With Chronic Obstructive Pulmonary Disease In Alberta, Canada

Abstract

Objectives

To describe the trends in pharmacologic treatment for patients newly diagnosed with chronic obstructive pulmonary disease (COPD) in Alberta, Canada.

Methods

We linked Alberta health databases to identify patients aged ≥35 years with incident COPD between April 2010 and March 2017. Incident cases were defined as those who did not have a hospitalization or outpatient visit with COPD in the previous 2 years. Patients were categorized into two groups: 1) incident cases at a hospital and 2) incident cases at an outpatient clinic, and both were followed until death or being censored by 31 March 2018. Utilization of COPD medication for 30 days following incident event and adherence in maintenance therapy over time were reported.

Results

The study included 33,169 patients with incident COPD (hospital: 9,089; outpatient: 24,080). In 18,666 (56.3%) patients starting medication within 30 days of the incident event (2010: 52.7%; 2016: 56.6%; p=0.002), SABA (60.5%) and LABA/ICS (41.6%) were most commonly used. ICS (without LABA) was used in 14.2% and was used as monotherapy in 4.5% of patients. The proportion of patients who initiated any ICS was similar (hospital: 56.7%; outpatient: 55.7%; p=0.194) and decreased in both settings over time (p<0.001). Drug adherence during the first year after the incident event was 54.3%, higher among hospital patients (66.5% vs 48.9%; p<0.001), and improved over time (2010: 53.4%; 2016: 57.4%; p<0.001).

Conclusion

The initiation of and adherence to pharmacologic therapy for patients with COPD is low but improves over time. While SABA and LABA/ICS are most commonly used, ICS utilization decreases over time.

Keywords:

• COPD
• drug utilization
• pharmacologic therapy
• Canada

Funding

This research has been commissioned and funded by the Ontario Lung Association, as part of Helping the Missing Million project.

Disclosure

The Lung Association - Ontario funded the research for this study with an unrestricted grant to the Institute of Health Economics (IHE). Dat T Tran and Ilke Akpinar are IHE employees. Dr Dat T Tran reports grants from Lung Association- Ontario, during the conduct of the study. Dr Ilke Akpinar reports grants from Lung Association - Ontario, during the conduct of the study. Dr Philip Jacobs reports grants from Lung Association - Ontario, during the conduct of the study; and grant from Boehringer Ingelheim to study COPD market. The authors report no other conflicts of interest to this work.