Impact of Therapy Persistence on Exacerbations and Resource Use in Patients Who Initiated COPD Therapy

Abstract

Purpose

This study assessed therapy persistence in patients with chronic obstructive pulmonary disease (COPD) in France, and the impact of non-persistence on exacerbations and described COPD-related healthcare resource use (HRU).

Methods

Patients aged ≥45 years who received ≥1 dispensed bronchodilator per quarter over three consecutive quarters between 2007 and 2014 and initiated specific COPD therapy were selected from the Echantillon Généraliste des Bénéficiaires (EGB) database. Persistence, defined as the absence of dispensing gaps of >90 days, was measured at 12 months. Exacerbations were compared between persistent and non-persistent patients during follow-up after patient matching and adjustment for confounding factors. COPD-related HRU during follow-up was described.

Results

Among 4020 patients with COPD, 2164 initiated a specific therapy. Of these, 54.4% stopped treatment within 12 months. Persistence with all COPD therapy regimens was low, particularly for inhaled corticosteroid (ICS; 25.6%) and ICS/twice-daily long-acting beta-agonist (39.4%) regimens. Among 721 persistent patients who were matched with 721 non-persistent patients, there was no difference in the number of moderate or severe exacerbations at 12 months. However, medical procedures (for instance, pulmonary function testing and chest X-rays) were more frequently observed among persistent patients than among non-persistent patients, suggesting worse disease severity.

Conclusion

Patients receiving specific treatment(s) for COPD demonstrated low persistence for all examined therapy regimens, with no clear impact of persistence status on the frequency of exacerbations at 12 months.

Keywords:

• COPD
• therapy
• persistence
• exacerbations
• healthcare resource use

Acknowledgements

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 the data. We also thank Gaëlle Le Moine for the coordination of the manuscript development.

This study was funded by GlaxoSmithKline plc. (study HO-16-17431).

Abbreviations

COPD, chronic obstructive pulmonary disease; EGB, Echantillon Généraliste des Bénéficiaires; FDC, fixed-dose combination; GP, general practitioner; HRU, healthcare resource use; ICD-10, International Classification of Diseases 10th Revision; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; LTD, long-term disease; NIV, non-invasive ventilation; OCS, oral corticosteroids; PFT, pulmonary function testing; SABA, short-acting beta-agonist; SAMA, short-acting muscarinic antagonist.

Disclosure

GN, and LS are employees of GlaxoSmithKline (GSK) and own stock in GSK. CCDS was an employee of GSK at the time of the study. EVG is Scientific Advisor for PELyon and has had work sponsored by GSK, during the conduct of the study. FJ, FD, and MB (employees of PELyon) conducted the study through sponsorship by GSK and were not paid for manuscript development. CC reports personal fees from GSK, AZ, Novartis, during the conduct of the study. The authors report no other conflicts of interest in this work.