Results

Post-propensity-score matching, a total of 2,908 patients identified (1,454 in each cohort) (see Figure 1).

Figure 1. Attrition diagram

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Patient characteristics

Post-match, cohorts were well balanced on baseline characteristics (standardized difference was ≤10%) (see Table 1).

Table 1. Post-match select patient characteristics by cohort

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Health care resource utilization

The TIO+OLO cohort had significantly lower annualized COPD-related acute inpatient stays (0.3 vs. 0.5, p<0.001; mean length of stay (LOS; 2.2 vs. 3.8 days, p=0.001), office visits (4.3 vs 5.4, p<0.001), outpatient visits (1.8 vs. 3.0, p<0.001) and other medical services (3.6 vs. 4.9, p<0.001) than the TT cohort while on treatment.
Annualized mean counts of COPD-related medication fills were 13.4 in the TIO+OLO cohort and 25.9 in the TT cohort (p<0.001) (see Figure 2).

Figure 2. COPD-related annualized mean counts by cohort

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Note. ***p≤0.001

Non-COPD pneumonia-related resource use was lower in the TIO+OLO cohort for acute inpatient stays (0.09 vs. 0.15), ER visits (0.07 vs. 0.11), office visits (0.12 vs. 0.23) and other medical visits (0.07 vs. 0.25; all p<0.05) (see Figure 3).
All-cause resource use was also lower in the TIO+OLO cohort for acute inpatient stays (0.4 vs. 0.6, p<0.001; mean LOS: 2.8 vs. 4.6 days, p<0.01), office visits (17.9 vs 19.9, p<0.01), outpatient visits (9.0 vs. 11.3, p<0.001) and other medical visits (9.5 vs. 13.1, p<0.001) (see Figure 4).
TIO+OLO patients had a significantly lower mean count of all‐cause pharmacy fills than TT patients (60.0 vs. 84.7, p<0.001; data not shown)

Figure 3. Non-COPD pneumonia-related annualized mean counts by cohort

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Note. *p<0.05

Figure 4. All-cause annualized mean counts by cohort

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Note. ***p<0.001
**p<0.01

Cost

The TIO+OLO cohort had significantly lower annualized mean costs than the TT cohort, including (see Figure 5):

COPD-related medical costs ($6,449 vs. $10,115; p=0.002; data not shown), acute inpatient stays ($4,316 vs. $7,370; p=0.006) and pharmacy costs ($3,646 vs. $7,020; p<0.001). Total mean COPD-related costs were therefore lower ($10,094 vs. $17,135; p<0.001).
Non-COPD pneumonia-related ambulatory costs ($23 vs. $59; p=0.037), office visits ($10 vs. $17; p=0.021; data not shown). Mean medical costs did not differ significantly.
All-cause mean medical costs ($12,613 vs. $17,319; p=0.001; data not shown), acute inpatient stays ($5,580 vs. $8,987; p=0.006) and pharmacy costs ($8,449 vs. $12,964; p<0.001). Total mean all-cause costs for TIO+OLO were also lower ($21,062 vs. $30,283; p<0.001).

Figure 5. Annualized health care costs by care category and cohort

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Note. There were no medications identified for non-COPD Pneumonia-related care; Ambulatory care included office and outpatient visits. Medical costs include acute inpatient stays, other medical, ER and ambulatory care. Total costs are the sum of medical and pharmacy.
***p<0.001; **p<0.01; *p<0.05