This is a retrospective observational study using the Optum Research Database.

Study inclusion criteria were:

• Initiation of COPD treatment (LAMA monotherapy, ICS+LABA, LAMA+LABA (TIO+OLO is a subset), TT in free or fixed-dose combinations) with ≥30 days of treatment between 01/01/2014 and 03/31/2018 (Identification period).
  • The date of treatment initiation was set as index date.

• ≥2 diagnoses for COPD on separate dates of service, in any position on the medical claim, during the study period (01/01/2013 to 05/31/2018).
• ≥40 years of age as of the index date, full demographic information.
• Continuous medical/pharmacy coverage for 12-months pre-index (baseline) and for ≥30 days post-index (follow-up).
• Medicare Advantage Part D (MAPD) insurance coverage.
• No asthma, cystic fibrosis, or lung cancer (identified with ≥2 diagnoses) during the study period.

• This post-hoc analysis examined TIO+OLO and TT initiators who were propensity score matched 1:1 to adjust for observed baseline differences.
  • Matching was conducted on baseline demographics, prescriber specialty, exacerbation history, comorbidities including pneumonia, COPD medication use, medical resource use and cost quartiles.

• Patients were followed while on treatment until the earliest occurrence of index regimen discontinuation (≥60 day gap) or switch, coverage disenrollment, or end of study period.

• COPD (or pneumonia)-related HCRU was defined as medical claims with a diagnosis of COPD (or pneumonia/acute bronchitis/bronchiolitis) in any position on the claim.
  • The claim’s corresponding health plan paid costs were considered for estimating the cost burden.

• Annualized population rates were calculated by cohort as (sum of events or cost/sum of observation on-treatment days)*365.