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Pharmacotherapies for COPD
P274 Comparison of the initiation of copd treatment with licensed fdc ics/laba treatments in terms of disease control and cost effectiveness
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  1. S Wan Yau Ming1,
  2. J Haughney2,
  3. D Ryan3,
  4. I Small4,
  5. F Lavorini5,
  6. K Gruffydd-Jones6,
  7. A Papi7,
  8. D Singh8,
  9. D Halpin8,
  10. J Hurst9,
  11. S Patel10,
  12. M Ochel10,
  13. D Price1
  1. 1Observational and Pragmatic Research Institute, Singapore
  2. 2Academic Primary Care, University of Aberdeen, Aberdeen, UK
  3. 3Optimum Patient Care, UK
  4. 4Peterhead Health Centre, Aberdeen, UK
  5. 5Department of Critical Care, University of Florence, Florence, Italy
  6. 6University of Bath, Bath, UK
  7. 7University of Ferrara, Ferrara, Italy
  8. 8Royal Devon and Exeter University Hospital, UK
  9. 9University College London, London, UK
  10. 10Chiesi Ltd, Singapore

Abstract

Several fixed-dose combination inhaled corticosteroid (FDC ICS/LABA) inhalers are licensed for chronic obstructive pulmonary disease (COPD) in the UK. This study compares effectiveness of Fostair 100/6 (BDP/FOR) metered dose inhalers (MDI) against other licensed FDC ICS/LABAs, namely; Seretide Accuhaler 500 (FP/SAL) dry powder inhaler (DPI) and Symbicort Turbohaler 200/6 and 400/24 DPI (BUD/FOR) in a patient group with recent exacerbations and poor lung function. A historical cohort study using data extracted from the Optimum Patient Care Research Database. Patients with diagnostic read codes for COPD, smoking history, age ≥35 years, postdose FEV1 percent predicted <55%,≥1 previous long acting bronchodilator ever, and ≥1 previous exacerbation in the 18 months prior initiation of FDC ICS/LABA therapy. The observation period consisted of one year after the initiation of FDC ICS/LABA for follow up and one year prior for patient characterisation. Patients were excluded if they switched or halted ICS/LABA treatment during the 1 year follow up period. The primary outcome was the proportion of patients with ≥1 exacerbation. The non-inferiority margin was defined as 20%. Patients were directly matched 1:1 on categorised age, smoking status, FEV1 percent predicted and exacerbations. Mean total costs consisting of medication/resource costs were compared between treatment arms after adjusting for confounders. Out of the patients prescribed BDP/FOR (n=537) and 537 FP/SAL (n=537), the median age was 70 and 69 respectively and 41.7% were current smokers. In the BDP/FOR (n=540) and BUD/FOR (n=540) comparison, the median age was 70 and 69 respectively, and 42% were current smokers. The risk of ≥1 exacerbation in BDP/FOR group was non-inferior during the year following the initiation of ICS/LABA compared to FP/SAL (OR 0.89, 95% CI: 0.67–1.19) or BUD/FOR (OR 0.79, 95% CI: 0.58–1.08). Cost was significantly lower for BDP/FOR versus FP/SAL (adjusted mean £730.0 versus £850.1 respectively, p<0.001) and lower for BDP/FOR versus BUD/FOR (adjusted mean £732.4 versus £757.2 respectively, p=0.054). Treatment with BDP/FOR is non-inferior in terms of exacerbation risk and is additionally associated with a lower point estimate of exacerbation risk, a lower cost compared to FP/SAL and BUD/FOR, and a lower ICS dose compared to FP/SAL.

https://doi.org/10.1136/thoraxjnl-2017-210983.416

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