An examination of a large database of employers, health plans, and public organizations revealed that persistence and adherence to therapy are greater and resource utilization and costs are less with the use of single long-acting inhalers compared with multiple long-acting inhalers in the treatment of chronic obstructive pulmonary disease (COPD), according to Andrew P. Yu, PhD, of Analysis Group, a consulting group in Boston, MA.
Dr Yu and colleagues examined a commercial medical claims database of 23,494 patients with COPD plus ≥2 medical claims. A matched-pair analysis was conducted of patients who used single inhalers versus those who used multiple inhalers. The patients were followed for 12 months.
Treatment discontinuation was defined as an interruption in prescription drug claims that lasted for ≥30 days. Adherence to inhaler treatment was estimated based on the proportion of days covered.
Adherence: Multiple versus Single Inhalers
Multiple-inhaler users were less adherent to their medication regimen than users of a single inhaler—79.2% of multiple-inhaler users were not adherent (defined as less than 80% of study medication use) compared with 71.5% of single-inhaler users.
After controlling for potential confounders, the proportion of days covered was 8.6% greater for singleinhaler users, who were 34% more likely to be adherent than the multipleinhaler users.
Over the 12 months, 86.7% of the multiple-inhaler users discontinued ≥1 of their index inhaler medications compared with 78.6% of the singleinhaler users (Table 1). After adjusting for confounders, multiple-inhaler users were 40% more likely to discontinue treatment.
Higher adherence to COPD medication is strongly associated with a lower risk for mortality and hospitalization for COPD exacerbations, Dr Yu noted. The lower adherence to multipleinhaler use may also be responsible for increased healthcare resource utilization in this group, he said.
Resource Utilization, Cost
Another analysis of the same database showed an increase in the number of healthcare visits for multiple-inhaler users (Table 2), resulting in higher healthcare costs for multiple-inhaler users versus single-inhaler users.
After adjusting for potential confounders, multiple-inhaler users had 64% more inpatient admissions for COPD, 20% more inpatient days, 27% more COPD-related emergency de - part ment visits, 10% more urgent care visits, and 6% more outpatient visits compared with single-inhaler users.
Incremental all-cause healthcare costs were higher for the multipleinhaler users compared with the costs of single-inhaler users. Compared with single-inhaler users, total healthcare costs for the 12 months of the study were $3319 greater for multiple- inhaler users; their medical costs were $1586 higher, and their pharmacy costs were $1776 higher.
Similarly, incremental costs for COPD-related healthcare costs were higher for multiple-inhaler users. The convenience of a single inhaler could explain the better adherence rate in this group, Dr Yu said.
This study was an observational study; therefore, although the re - search ers controlled for proxies of disease severity to reduce bias, “multipleinhaler users may still have had a little more severe disease to begin with, which could have affected exacerbation rates and outcomes,” said Dr Yu. He noted that for now, the most convenient inhaler regimen that controls disease may be the best option.