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8847

Clinical and economic outcomes for patients initiating fluticasone propionate/salmeterol combination therapy (250/50 mcg) versus anticholinergics in a comorbid COPD/depression population

Original Research

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Authors: Dalal AA, Shah M, D'Souza AO, Chaudhari S, Crater G

Published Date January 2012 Volume 2012:7 Pages 11 - 19
DOI: http://dx.doi.org/10.2147/COPD.S27846

Anand A Dalal1, Manan Shah2, Anna O D'Souza2, Sham Chaudhari2, Glenn Crater1
1GlaxoSmithKline, Research Triangle Park, NC, USA; 2Xcenda LLC, Palm Harbor, FL, USA

Background: Chronic obstructive pulmonary disease (COPD) is frequently associated with comorbid depression and anxiety. Managing COPD symptoms and exacerbations through use of appropriate and adequate pharmacotherapy in this population may result in better COPD-related outcomes.
Methods: This retrospective, observational study used administrative claims of patients aged 40 years and older with COPD and comorbid depression/anxiety identified from January 1, 2004 through June 30, 2008. Patients were assigned to fluticasone propionate/salmeterol 250/50 mcg combination (FSC) or anticholinergics (AC) based on their first (index) prescription. The risks of COPD exacerbations and healthcare utilization and costs were compared between cohorts during 1 year of follow-up.
Results: The adjusted risk of a COPD-related exacerbation during the 1-year follow-up period was 30% higher in the AC cohort (n = 2923) relative to the FSC cohort (n = 1078) (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.08–1.56) after controlling for baseline differences in covariates. The risks of COPD-related hospitalizations and emergency department visits were 56% and 65% higher, respectively, in the AC cohort compared with the FSC cohort. The average number of COPD-related hospitalizations during the follow-up period was 46% higher for the AC cohort compared with the FSC cohort (incidence rate ratio [IRR]: 1.46, 95% CI: 1.01–2.09, P = 0.041). The savings from lower COPD-related medical costs ($692 vs $1042, P < 0.050) kept the COPD-related total costs during the follow-up period comparable to those in the AC cohort ($1659 vs $1677, P > 0.050) although the pharmacy costs were higher in the FSC cohort.
Conclusions: FSC compared with AC was associated with more favorable COPD-related outcomes and lower COPD-related utilization and medical costs among patients with COPD and comorbid anxiety/depression.

Keywords: COPD, fluticasone propionate/salmeterol, anticholinergics, depression, comorbidity





 

Other articles by Dr Anand Dalal

Burden of COPD in a government health care system: a retrospective observational study using data from the US Veterans Affairs population
Comparative cost-effectiveness of a fluticasone-propionate/salmeterol combination versus anticholinergics as initial maintenance therapy for chronic obstructive pulmonary disease
Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009
Direct costs of chronic obstructive pulmonary disease among managed care patients
Severity of COPD at initial spirometry-confirmed diagnosis: data from medical charts and administrative claims
The role of fluticasone propionate/salmeterol combination therapy in preventing exacerbations of COPD
Validation of alternate modes of administration of the lung function questionnaire (LFQ) in subjects with smoking history


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