Aim To characterise disease burden, health care resource utilisation (HCRU), and costs among a cohort of COPD patients newly prescribed maintenance therapy in UK general practice.
Method A retrospective cohort of COPD patients aged ≥40 yrs and newly prescribed COPD monotherapy (long acting beta-agonists [LABA] or long acting muscarinic antagonist [LAMA]), dual therapy (LABA+LAMA; LABA+inhaled corticosteroid (ICS); LAMA+ICS) or open triple therapy (LAMA+LABA+ICS) between 1/1/2009 and 30/11/2012 was identified from UK Clinical Practice Research Datalink (CPRD).
Health care resource utilisation assessed in the 12 months prior to maintenance therapy initiation included moderate (community treated) and severe (hospital or A&E treated) COPD exacerbations (rate per 100 person years [PY]), general practice (GP) interactions, other COPD treatments, and non-COPD related hospitalisations. The costs associated with HCRU were calculated using National Health Services reference costs for 2013–14 and PSSRU costs for 2014.
Results A total of 39,639 COPD patients were included (54% male, mean age 68 yrs (SD: 11)). LABA+ICS (39%) and LAMA (34%) were the most commonly initiated LABD; 13% were first exposed to LABD as part of an open triple regimen (Table 1). Patients initiating an ICS-containing regimen had a higher exacerbation rate (moderate or severe) in the 12 months prior to maintenance therapy initiation (LABA+ICS: 0.74 per PY [95% CI:0.72–0.75]; LAMA+ICS: 0.86 per PY [0.82–0.90] and LAMA+LABA+ICS: 0.83 per PY [0.80–0.85]) compared to patients on bronchodilators alone (LAMA: 0.55 per PY [0.54–0.57]; LABA: 0.56 per PY [0.54–0.59]; LAMA+LABA: 0.50 per PY [0.44–0.56]). Patients on open triple therapy demonstrated the highest rates of non-COPD related hospitalisations. The annual per patient cost ranged from £2,139 (LABA) to £2,876 (LAMA+LABA+ICS); approximately half were due to GP visits and a third resulted from non-COPD related hospitalisations (Table 1).
Conclusion Patients with a higher baseline exacerbation rate were more likely to receive ICS- containing therapies compared to those taking bronchodilators alone. Across all maintenance therapy groups, GP visits and non-COPD related hospitalisations were the primary driver of total costs.