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Association Between Adherence to Maintenance Medication in Patients with COPD and Acute Exacerbation Occurrence and Cost in China: A Retrospective Cohort Database Study

Authors Chen R, Gao Y, Wang H, Shang H, Xuan J

Received 11 October 2019

Accepted for publication 27 March 2020

Published 4 May 2020 Volume 2020:15 Pages 963—971

DOI https://doi.org/10.2147/COPD.S234349

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Chunxue Bai


Rongchang Chen,1 Yue Gao,2 He Wang,3 Hongyan Shang,3 Jianwei Xuan4

1State Key Laboratory of Respiratory Disease, National Clinical Research Center, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Health Economics, Shanghai Centennial Scientific Co. Ltd., Shanghai, People’s Republic of China; 3Medical Affairs, AstraZeneca China, Shanghai, People’s Republic of China; 4Health Economics Research Institute, Sun Yat-Sen University, Guangzhou, People’s Republic of China

Correspondence: Rongchang Chen
State Key Laboratory of Respiratory Disease, National Clinical Research Center, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
Tel +86 20 83062870
Email chenrc@vip.163.com

Background: This study aimed to evaluate the association between adherence to maintenance medication (ie, inhaled bronchodilators, inhaled corticosteroid/long-acting beta-2 agonist [ICS/LABA] combinations, and oral therapy) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and related costs among patients with chronic obstructive pulmonary disease (COPD) in China.
Patients and Methods: Claims data from the hospitals of a metropolitan city in south China between January 2014 and December 2016 were obtained. Patients with COPD with ≥ 2 maintenance medication claims during 1 year were included. Adherence was measured by the proportion of days covered (PDC). The interaction of medication class×adherence was considered when building models.
Results: A total of  11,708 patients met the inclusion criteria, of whom 10.8% were highly adherent (PDC≥ 0.8). There were significant interaction effects of drug category on hospitalized AECOPD risk (P≤ 0.001), hospitalized AECOPD rate (P< 0.001), and 1-year hospitalized AECOPD treatment costs (P=0.012). There was a relationship between high adherence and outcomes for ICS/LABA combinations (n=3,419), ie, relative risk of hospitalized AECOPD was reduced by 34.8% (adjusted odds ratio=0.65; 95% confidence interval (CI): 0.54– 0.79; P< 0.001) while the frequency of hospitalized AECOPD per patient-year was reduced by 24.4% (adjusted rate ratio=0.76; 95% CI: 0.65 to 0.87; P< 0.001). Mean 1-year per-patient hospitalized AECOPD costs were reduced by 37.8% (mean difference=− 848 USD; 95% CI: − 1435– 262 USD; P< 0.001). Patients taking oral mucolytics and having high adherence had worse AECOPD outcomes than patients with poor adherence.
Conclusion: High adherence to ICS/LABA maintenance therapy was associated with reduced hospitalized AECOPD rates and costs in Chinese patients with COPD.

Keywords: chronic obstructive pulmonary disease, adherence, acute exacerbation of chronic obstructive pulmonary disease, cost, ICS/LABA

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