Clinical and Economic Consequences of Inhaled Corticosteroid Doses and Particle Size in Triple Inhalation Therapy for COPD: Real-Life Study

Abstract

Objective

To determine the clinical and economic consequences of inhaled corticosteroid doses and particle size in patients on triple-inhalation therapy for COPD.

Methods

Patients aged ≥40 years who initiated treatment with multi-inhaler triple-inhaled therapy between 1 January 2015 and 31 March were included and followed for 1 year. Patients were grouped according to inhaled corticosteroid (ICS) dose (low/medium/high) and particle size device (extrafine/non-extrafine particles). Outcome variables were moderate and severe exacerbations, pneumonia and healthcare resource use (HCRU) costs. A multivariate analysis was performed for model correction (p<0.05).

Results

A total of 2185 patients (mean age 72.3 years, 82.9% male) were analysed. Of these, 849 (38.9%) patients received low-dose ICS, 612 medium-dose ICS (28.0%) and 724 (33.1%) high-dose ICS. Exacerbations occurred more frequently with increasing IC dose (low: 26.4%, medium: 28.7% and high: 30.4%; p=0.047), as did the proportion of pneumonia (3.4%, 4.2% and 6.9%, respectively (p=0.041)). The annual mean cost/unit was € 2383 for low dose, € 2401 for medium dose and € 2625 for high dose (p=0.024). Four hundred and sixty-two (31.6%) patients used an extrafine particle device and 999 (68.4%) a non-extrafine particle device: the proportion of exacerbations was 24.0% vs 30.4% (p=0.012), and the annual mean cost/unit was € 2090 vs € 2513, respectively (p<0.001). The number of exacerbations was directly correlated with FEV ₁ (β= −0.157), age (β=0.071), Charlson index (β=0.050) and device type (extrafine: β=0.049) (p<0.02).

Conclusion

In patients with COPD receiving multi-inhaler triple therapy, higher ICS doses were not associated with a further reduction in exacerbations, whereas we found an increased risk of pneumonia. The use of inhaler devices delivering extrafine ICS particle was associated with a lower rate of exacerbations, resulting in lower overall HCRU costs.

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): copd

Journal ID (pmc): copd

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date (Electronic): 09 December 2020

Publication date Collection: 2020

Volume: 15

Pages: 3291-3302

Affiliations

[1 ]Health Economics & Outcomes Research, Atrys Health , Barcelona, Spain

[2 ]Unidad de Farmacología Clínica, Hospital Universitario Príncipe de Asturias , Madrid, Spain

[3 ]Departamento de Ciencias Biomédicas, Universidad de Alcalá (IRYCIS) , Madrid, Spain

[4 ]Departamento de Medicina y Especialidades, Universidad de Alcalá , Madrid, Spain

[5 ]Servicio de Neumología, Hospital Universitario de Guadalajara , Guadalajara, Spain

Author notes

Correspondence: Antoni Sicras-Mainar Atrys Health SA , C/Provença 392, bajos, Barcelona08025SpainTel [phone] Email [e-mail]

Article

Publisher ID: 281333

DOI: 10.2147/COPD.S281333

PMC ID: 7734046

Copyright statement: © 2020 Sicras-Mainar et al.

License:

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Page count

Figures: 1, Tables: 18, References: 35, Pages: 12

Funding

Funded by: Chiesi España S.A.U;

This study was funded by Chiesi España S.A.U.

Categories

Subject: Original Research