Swetha R. Palli, MS1, Amy J. Anderson, MS2, Lisa Le, MS2, Monica Frazer, PhD2, Mary DuCharme, MLIS2, Ami R. Buikema, MPH2, Jessica Franchino-Elder, PhD1
1Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 2Optum, Inc. Eden Prairie, MN, USA
Introduction
- Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death in the USi and the only one of the top 6 causes of death that continues to increase in incidence.ii
- The estimated total US economic burden of COPD in 2010 was $42.6 billion in direct healthcare expenditures, of which $11.3 billion were for hospital care.iii
- COPD exacerbations account for the majority of the total COPD burden on the healthcare system, with up to 70% of COPD-related healthcare expenditures attributable to acute exacerbations of COPD.
- Exacerbations of COPD account for approximately 10% of all medical admissions.iv COPD was among the most frequent reason for hospital readmissions among Medicare beneficiaries with an all-cause 30-day readmission rate of approximately 23%.iv
- COPD hospital readmissions due to exacerbations account for about $15 billion USD in annual direct costs, and these costs are projected to rise by approximately 53% in the coming years.v
- 2018 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations identify dual therapy with long-acting muscarinic antagonists (LAMAs) plus long-acting beta2 agonists (LABAs) for patients who have persistent symptoms and/or exacerbations on LAMA or LABA monotherapy, with escalation to Triple Therapy (TT; LAMA+LABA+inhaled corticosteroids [ICS]) recommended in case of further exacerbation and after assessing the risks/benefits (e.g., pneumonia is one of the adverse events linked to ICS).
- Despite these recommendations, evidence suggests TT is over-prescribed across all COPD severities. This deviation from GOLD recommendations may have an economic and outcomes impact.v
- Retrospective observational studies comparing tiotropium+olodaterol (TIO+OLO) - a fixed-dose LAMA+LABA combination inhaler therapy - have shown superior results over TT within intent-to-treat and on-treatment real-world studies.vi,vii