A US database study characterizing patients initiating a budesonide–formoterol combination versus tiotropium bromide as initial maintenance therapy for chronic obstructive pulmonary disease

Abstract

Objective

To compare clinical and demographic characteristics, resource utilization and costs of chronic obstructive pulmonary disease (COPD) patients prior to initiating budesonide–formoterol combination (BFC) or tiotropium-maintenance therapy.

Materials and methods

This cross-sectional study used claims-based diagnosis to identify COPD patients in the HealthCore Integrated Research Database who initiated BFC or tiotropium therapy between March 1, 2009 and January 31, 2012 (intake period); the index date was defined as the initial prescription fill for either agent. Patients diagnosed with respiratory tract cancer or receiving inhaled corticosteroids/long-acting β₂-adrenergic agonists or tiotropium in 12 months prior to index date were excluded. Categorical variables were evaluated with χ² tests; mean cost differences were evaluated using γ-regression.

Results

Overall, 6,940 BFC and 10,831 tiotropium patients were identified. The BFC group was younger (mean age 64 versus 67 years), with a greater proportion of females (54% versus 51%). BFC-treated patients had more comorbid respiratory conditions, including asthma (25% versus 13%), but fewer comorbid cardiovascular conditions, including atherosclerosis (7% versus 10%) and myocardial infarction (4% versus 6%). A greater proportion of BFC patients received prior respiratory medication, including oral corticosteroids (46% versus 35%) and short-acting β₂-agonists (44% versus 35%). Tiotropium-treated patients had a greater mean number of COPD-related outpatient visits (4.6 versus 4.1). BFC-treated patients had lower total all-cause ($17,259 versus $17,926) and COPD-related ($1,718 versus $1,930) health care costs, driven by lower all-cause and COPD-related inpatient expenditures.

Conclusion

Initiators of BFC or tiotropium showed differences in clinical and demographic characteristics and health care utilization and costs prior to starting COPD maintenance therapy.

Keywords:

• observational study
• retrospective analysis
• chronic respiratory condition
• outcome research
• health care utilization and costs

Acknowledgments

This study was funded by AstraZeneca. Bernard B Tulsi, MSc provided writing and other editorial support for this manuscript.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work. This submission complies with all ICMJE conditions.

Disclosure

This manuscript represents original research by the eight listed authors. Three of the authors (DMK, OT, and SZ) and the medical writer (BBT) are employees of HealthCore Inc., a wholly owned research and consulting subsidiary of WellPoint, a national health insurance company. Five of the authors (SAW, NP, HE, CW, and FT) are employees of AstraZeneca, which provided funding for this study. The authors report no other conflicts of interest in this work.