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COMPARISON OF PATİENTS WİTH CHRONIC OBSTRUCTIVE PULMONARY DISEASE THAT HOSPİTALIZED IN UNİVERSİTY HOSPİTAL AND STATE HOSPİTAL. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1027531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cost-effectiveness of umeclidinium as add-on to ICS/LABA therapy in COPD: A UK perspective. Respir Med 2018; 145:130-137. [DOI: 10.1016/j.rmed.2018.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/17/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022]
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Buikema AR, Brekke L, Anderson A, Koep E, Van Voorhis D, Sharpsten L, Hahn B, Ray R, Stanford RH. The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models. Multidiscip Respir Med 2018; 13:38. [PMID: 30338068 PMCID: PMC6180385 DOI: 10.1186/s40248-018-0151-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/20/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with high clinical and economic burden. Optimal pharmacological therapy for COPD aims to reduce symptoms and the frequency and severity of exacerbations. Umeclidinium/vilanterol (UMEC/VI) is an approved combination therapy for once-daily maintenance treatment of patients with COPD. This study evaluated the impact of delaying UMEC/VI initiation on medical costs and exacerbation risk. METHODS A retrospective analysis of patients with COPD who initiated UMEC/VI between 4/28/2014 and 7/31/2016 was conducted using the Optum Research Database. The index date was the first COPD visit after UMEC/VI available on US formulary (Commercial 4/28/2014; Medicare Advantage 1/1/2015). Patients were followed for 12 months post-index, and categorized into 12 cohorts corresponding to month (30-day period) of UMEC/VI initiation (i.e. Months 1-12) post-index. The outcomes studied during the follow up period included COPD-related and all-cause medical costs, and risk of COPD exacerbations. Marginal structural models (MSM) were used to control for time-varying confounding due to changes in treatment and severity during follow up. RESULTS 2,200 patients initiating UMEC/VI were included in the study sample. Patients' average age was 69.3 years, 49.9% were female and 69.7% were Medicare insured. Following MSM analysis, 12-month adjusted COPD-related medical costs increased by 2.9% (95% confidence interval [CI]: 0.1-5.9%; p = 0.044) for each monthly delay in UMEC/VI initiation, with a 37.4% higher adjusted cost for patients initiating UMEC/VI in Month 12 versus Month 1 ($13,087 vs. $9524). The 12-month adjusted all-cause medical costs increased by 2.8% (95% CI: 0.6-5.2%; p = 0.013) for each monthly delay, with a 36.1% higher adjusted cost for patients initiating UMEC/VI at Month 12 versus Month 1 ($22,766 vs. $16,727). The monthly risk of severe exacerbation was significantly higher in patients who had not yet initiated UMEC/VI than those who had (hazard ratio: 1.74; 95% CI: 1.35-2.23; p < 0.001). CONCLUSIONS Prompt use of UMEC/VI following a physician visit for COPD appears to result in economic and clinical benefits, with reductions in medical costs and exacerbation risk. Additional research is warranted to assess the benefits of initiating UMEC/VI as a first-line therapy compared with escalation to UMEC/VI from monotherapies.
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Affiliation(s)
- Ami R. Buikema
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Lee Brekke
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Amy Anderson
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Eleena Koep
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Damon Van Voorhis
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Lucie Sharpsten
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Beth Hahn
- US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398 USA
| | - Riju Ray
- US Medical Affairs, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398 USA
| | - Richard H. Stanford
- US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC 27709-3398 USA
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Ding Y, Niu H, Li Y, He P, Li Q, Ouyang Y, Li M, Hu Z, Zhong Y, Sun P, Jin T. Polymorphisms in VEGF-A are associated with COPD risk in the Chinese population from Hainan province. J Genet 2016; 95:151-6. [PMID: 27019442 DOI: 10.1007/s12041-016-0627-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this study, we examined and validated how common variants contribute to susceptibility to chronic obstructive pulmonary disease (COPD) in the Han Chinese population. Here, we genotyped 18 nucleotide polymorphisms and evaluated their association with COPD using chi-square test and genetic model analysis (246 COPD patients and 350 controls), and found three SNPs that might cause a predisposition to COPD. Both rs3025030 and rs3025033 are located on chromosome 6 in VEGF-A. We found one risk allele 'C' from rs3025030 and another 'G' from rs3025033 using the log-additive model (OR 1.40; 95% CI 1.05-5.96; P = 0.022), (OR 1.38; 95% CI 1.03-1.84; P = 0.03). We also found another risk allele 'A' of rs9296092 in gene region ZBTB9-BAK1 by the allele model (OR 2.63; 95% CI 1.27-5.45; P = 0.0078), (adjusted OR 3.53; 95% CI 1.12-11.11; P = 0.031).We found a risk haplotype 'CG' associated with the risk of COPD (OR 1.39; 95% CI 1.04-1.86; P = 0.028). Our results when compared with previous studies showed significant association between VEGF-A polymorphism and COPD. We also identified rs9296092 as a risk factor for COPD.
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Affiliation(s)
- Yipeng Ding
- Department of Emergency, People's Hospital of Hainan Province, Haikou, Hainan 570311,People's Republic of China
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Milewska A, Rysiak E, Zareba I, Holownia A, Mroz RM. Costs of Treatment of Chronic Obstructive Pulmonary Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 885:67-75. [PMID: 26801145 DOI: 10.1007/5584_2015_199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The aim of this study was to analyze direct costs of COPD therapy in relation with clinical course and stage of the disease. Sixty patients with moderate to severe COPD were included into the study. The average cost was taken from institutional data file and was also assessed from a social perspective. Results were presented as average costs per patient per year. Forty two percent of patients was classified as GOLD D category, while categories A, B, and C accounted for 8 %, 27 %, and 23 %, respectively. Approximately 65 % of patients had 2-3 degrees of dyspnea according to the Modified Medical Research Council Dyspnea Scale. About 60 % of patients underwent two or three exacerbations per year and those patients had one or two co-morbidities diagnosed. Treatment costs almost doubled with disease progression, mainly due to exacerbations. In patients in Group C and Group D with exacerbations the direct costs were several times higher than in group A or B and the difference increased with progression of the disease. In Groups A and B, the costs of treatment of stable disease or with exacerbation were comparable. We conclude that costs of treatment of COPD patients were highest in advanced disease and were strongly related to COPD exacerbations.
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Affiliation(s)
- A Milewska
- Respiratory Medicine Center, 9a Piasta St., 15-044, Bialystok, Poland
| | - E Rysiak
- Department of Medicinal Chemistry, Bialystok Medical University, 2d Mickiewicza St., 15-222, Bialystok, Poland
| | - I Zareba
- Department of Medicinal Chemistry, Bialystok Medical University, 2d Mickiewicza St., 15-222, Bialystok, Poland
| | - A Holownia
- Department of Clinical Pharmacology, Bialystok Medical University, 15a Waszyngtona St., Bialystok, Poland
| | - R M Mroz
- Respiratory Medicine Center, 9a Piasta St., 15-044, Bialystok, Poland. .,Department of Lung Diseases and Tuberculosis, Bialystok Medical University, 14 Zurawia St., 15-540, Bialystok, Poland.
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Eklund O, Afzal F, Borgström F, Flavin J, Ternouth A, Ojanguren ME, Crespo C, Baldwin M. Cost-effectiveness of tiotropium versus glycopyrronium in moderate to very severe chronic obstructive pulmonary disease in Canada, Spain, Sweden, and the UK. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:243-52. [PMID: 27354818 PMCID: PMC4910617 DOI: 10.2147/ceor.s105579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Tiotropium (TIO), Spiriva® Handihaler®, is a well-established bronchodilator, LAMA (long acting muscarinic antagonist), for the treatment of moderate to very severe chronic obstructive pulmonary disease (COPD). Clinical evidence from the SPARK trial suggests that TIO is superior to glycopyrronium (GLY), Seebri® Breezhaler®, in terms of severe exacerbations. This modeling study assessed the cost-effectiveness of TIO versus GLY for Canada (CAN), Spain (ESP), Sweden (SWE), and the UK, making use of this new clinical evidence. METHODS A Markov cohort model, with moderate to very severe (Global Initiative for Chronic Obstructive Lung Disease II-IV) COPD patients, was populated with efficacy data from the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) and SPARK trials as well as costs, utilities, and epidemiological data relevant for each country. Treatment efficacy was modeled as improvements in lung function, quality-adjusted life years (QALYs), and as a lowering of the risk of exacerbations (rate of exacerbations). Risks of exacerbations differed between cohorts based on data from SPARK. Health and cost outcomes were simulated over an approximate lifetime horizon, starting from the age of 65 years. Robustness of results was validated in deterministic sensitivity analyses. RESULTS Over the lifetime horizon, patients treated with TIO accumulated -623 (CAN), 1,066 (ESP), 1,137 (SWE), and -169 (UK), respectively, in incremental costs (€2014). TIO generated better health outcomes compared to GLY in all countries, 0.21 (CAN), 0.25 (ESP), 0.23 (SWE), and 0.23 (UK) in incremental QALYs. The cost per QALY gained was found to be €4,281 and €1,137 for ESP and SWE, respectively, while TIO was found to be cost saving in CAN and the UK. The results were mainly driven by the relative risk of severe exacerbations found in SPARK (GLY/TIO relative risk: 1.43, 95% confidence interval: 1.05-1.97, P=0.025). CONCLUSION The results from this study show that TIO is a cost-effective treatment compared to GLY in moderate to very severe COPD. The cost per QALY is well below the existing implicit and explicit willingness-to-pay thresholds.
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Affiliation(s)
| | | | | | | | | | | | - Carlos Crespo
- Boehringer Ingelheim, Sant Cugat del Vallès, Barcelona, Spain
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Roberts MH, Borrego ME, Kharat AA, Marshik PL, Mapel DW. Economic evaluations of fluticasone-propionate/salmeterol combination therapy for chronic obstructive pulmonary disease: a review of published studies. Expert Rev Pharmacoecon Outcomes Res 2016; 16:167-92. [PMID: 26839089 DOI: 10.1586/14737167.2016.1148602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review identifies and evaluates the comprehensive reporting of peer-reviewed economic evaluations of the effectiveness of fluticasone-propionate/salmeterol combination (FSC) therapy for maintenance treatment of chronic obstructive pulmonary disease (COPD). Economic evaluations were included if published in English since 2003. Evaluation categories included in the review were cost-effectiveness, cost-utility, and cost-consequence analyses. FSC is cost-effective in comparison to short-acting bronchodilators (SABDs). Cost and outcome differences between FSC and other long-acting therapies were modest. Studies exhibited large variations in populations, designs and environment, limiting the ability to draw conclusions. Many new maintenance treatments for COPD have been approved since 2010. Most have yet to be compared to older treatments like FSC. Evaluations are needed that consider costs and outcomes from a societal perspective (e.g., patients' ability to keep working) and evaluations that include subgroup analyses to investigate differential impacts according to clusters of patient characteristics.
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Affiliation(s)
- M H Roberts
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA.,b LCF Research, Health Services Research Division , Albuquerque , NM , USA
| | - M E Borrego
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA
| | - A A Kharat
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA
| | - P L Marshik
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA
| | - D W Mapel
- b LCF Research, Health Services Research Division , Albuquerque , NM , USA
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Eklund O, Afzal F, Borgström F. Cost-effectiveness of tiotropium versus usual care and glycopyrronium in the treatment of chronic obstructive pulmonary disease in Sweden. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:13. [PMID: 26288574 PMCID: PMC4539698 DOI: 10.1186/s12962-015-0040-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Tiotropium (TIO) is a well-established bronchodilator, LAMA (long-acting anticholinergic), for the treatment of moderate to very severe chronic obstructive pulmonary disease (COPD). Clinical evidence suggests that tiotropium is superior to usual non-LAMA care (UC) but may also have benefits compared to other LAMAs in preventing and limiting the effects of severe exacerbations. The primary objective of this study was to undertake a cost-effectiveness analysis of adding tiotropium to usual care versus usual care alone. A secondary objective was to assess the cost-effectiveness of tiotropium compared to glycopyrronium (GLY), another LAMA. The study was conducted with a Swedish setting in mind. Methods A Markov cohort model, incorporating the effects of exacerbations, was populated with efficacy data from the UPLIFT and SPARK trials and epidemiological data relevant for a Swedish patient population. Treatment efficacy of tiotropium was modelled as a lowering of the risk of exacerbations and as a slow-down of overall disease progression. The model followed patients over their remaining life-time. Results The base case analysis showed that patients treated with tiotropium gained 0.07 quality-adjusted life years (QALYs) compared to usual care alone at an incremental cost of SEK 15,041, resulting in a cost per QALY gained of SEK 224,850. Compared to glycopyrronium the QALY gained was estimated to 0.23 QALYs in favour of tiotropium at an incremental cost of SEK 2423, yielding a cost per QALY gained of SEK 10,456. The results were mainly driven by differences in the risk of severe exacerbations. Conclusion At the current implicit willingness-to-pay (WTP) per QALY threshold in Sweden, the results from this study indicate that tiotropium is a highly cost-effective intervention when added to usual non-LAMA care in the treatment of moderate to very severe COPD in Sweden. In addition, tiotropium is a highly cost-effective intervention when compared to glycopyrronium monotherapy.
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Affiliation(s)
| | - Faraz Afzal
- Boehringer Ingelheim Norway KS, Asker, Norway
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Mapel DW, Roberts MH. Management of asthma and chronic obstructive pulmonary disease with combination inhaled corticosteroids and long-acting β-agonists: a review of comparative effectiveness research. Drugs 2015; 74:737-55. [PMID: 24797158 PMCID: PMC4030099 DOI: 10.1007/s40265-014-0214-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The value of combination therapy with inhaled corticosteroids and long-acting β-agonists (ICS/LABA) is well recognized in the management of asthma and chronic obstructive pulmonary disease (COPD). Despite differences in the pharmacological properties between two well-established ICS/LABA products (budesonide/formoterol and fluticasone/salmeterol), data from randomized clinical trials (RCTs) and meta-analyses suggest that these two products perform similarly under RCT conditions. In contrast, a few recently reported real-world comparative effectiveness studies have suggested that there are substantial differences between ICS/LABA combination treatments in terms of clinical and healthcare outcomes in patients with asthma or COPD. The purpose of this article is to provide a brief review of the benefits, as well as the limitations, of comparative effectiveness research (CER) in the therapeutic area of asthma and COPD. We conducted a structured literature review of the current CER studies on ICS/LABA combinations in asthma and COPD. These articles were then used to illustrate the unique challenges of CER studies, providing a summary of study results and limitations. We focus particularly on difficult biases and confounding factors that may be introduced before, during, and after the initiation of therapy. Beyond being a review of these two ICS/LABA combination treatments, this article is intended to help those who wish to assess the quality of CER published projects in asthma and COPD, or guide investigators who wish to design new CER studies for chronic respiratory disease treatments.
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Affiliation(s)
- Douglas W Mapel
- Lovelace Clinic Foundation, 2309 Renard Place SE, Albuquerque, NM, 87106, USA,
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Roberts MH, Mapel DW, Thomson HN. The impact of chronic pain on direct medical utilization and costs in chronic obstructive pulmonary disease. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:173-84. [PMID: 25870513 PMCID: PMC4381884 DOI: 10.2147/ceor.s80424] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine how pain affects health care utilization and direct medical costs in individuals with chronic obstructive pulmonary disease (COPD) compared to patients with other chronic diseases. STUDY DESIGN A retrospective cohort analysis using administrative data of a managed health care system in the Southwestern US for years 2006-2010. METHODS COPD patients age ≥40 years were matched to similar patients with other chronic conditions on age, sex, insurance type, and a health care event (outpatient visit, emergency department visit, or inpatient stay). Chronic pain was indicated by pain-associated diagnoses and procedures, or fills for prescription pain medications. The study population was also stratified into those with and without chronic pain to examine clinical factors and costs associated with chronic pain. RESULTS Seven thousand nine hundred and fifty-two COPD patients (mean age 69 years, 58% women) were matched to 15,904 patients with other chronic disease. COPD patients had significantly higher utilization for pain-related services and for overall services. COPD patients had a higher prevalence of any pain medication use over a 12-month period (41.2% versus 31.5%) and, among those using pain medications, a higher mean number of pain medication prescription fills (10.1 versus 6.4). Factors associated with chronic pain included age 40-65 years, being female, having more than one chronic morbidity, insurance type, some emergency department or hospital utilization, and having either COPD, heart failure, arthritis, or stroke. Among COPD patients, those with chronic pain had a mean annual direct cost for overall utilization of $24,261 versus $10,390 among those without chronic pain (P<0.0001 for all comparisons). CONCLUSION COPD patients have substantially more utilization for pain medications and pain-related procedures than those with most other chronic diseases. Total direct medical costs among COPD patients who have chronic pain are more than double those of COPD patients without chronic pain. Pain management may be an opportunity for better and more cost-effective care for COPD patients.
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Casaburi R, Duvall K. Improving early-stage diagnosis and management of COPD in primary care. Postgrad Med 2014; 126:141-54. [PMID: 25141252 DOI: 10.3810/pgm.2014.07.2792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, but it often remains undetected in its mild and moderate forms. Patients frequently remain undiagnosed and untreated until the disease has become severe and debilitating, greatly impacting their quality of life. Primary care physicians (PCPs) are most often the first point of contact, and therefore they are in the best position to identify patients at risk of COPD in the early stages. Consequently, they play a critical role in the management of the disease, particularly smoking cessation. One of the earliest symptoms is activity-related dyspnea and subsequent exercise intolerance, often compensated for by reduction in physical activity. This review addresses the approaches used to identify COPD in the primary care setting, including simple tools such as handheld spirometers and questionnaires. A recent study demonstrated that, compared with usual care, use of the COPD Population Screener questionnaire alone and in combination with the copd-6 handheld spirometer significantly improved the odds of referral of patients with suspected COPD for pulmonary function testing or to a pulmonologist. Identification of patients suspected of having the disease and differentiation of COPD from asthma are important in order that treatment can be initiated in the mild stages to slow or prevent disease progression and reduce the risk of exacerbations. The review also discusses the evidence to date on pharmacologic treatment using short-acting and long-acting anticholinergics and β2-agonists, and nonpharmacologic interventions, such as smoking cessation, pulmonary rehabilitation, and influenza and pneumococcal vaccination in patients with mild and moderate COPD.
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Affiliation(s)
- Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
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Blasi F, Cesana G, Conti S, Chiodini V, Aliberti S, Fornari C, Mantovani LG. The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease: a cohort of hospitalized patients. PLoS One 2014; 9:e101228. [PMID: 24971791 PMCID: PMC4074190 DOI: 10.1371/journal.pone.0101228] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a common disease with significant health and economic consequences. This study assesses the burden of COPD in the general population, and the influence of exacerbations (E-COPD) on disease progression and costs. METHODS This is a secondary data analysis of healthcare administrative databases of the region of Lombardy, in northern Italy. The study included ≥ 40 year-old patients hospitalized for a severe E-COPD (index event) during 2006. Patients were classified in relation to the number and type of E-COPD experienced in a three-year pre-index period. Subjects were followed up until December 31st, 2009, collecting data on healthcare resource use and vital status. RESULTS 15857 patients were enrolled -9911 males, mean age: 76 years (SD 10). Over a mean follow-up time of 2.4 years (1.36), 81% of patients had at least one E-COPD with an annual rate of 3.2 exacerbations per person-year and an all-cause mortality of 47%. A history of exacerbation influenced the occurrence of new E-COPD and mortality after discharge for an E-COPD. On average, the healthcare system spent 6725€ per year per person (95%CI 6590-6863). Occurrence and type of exacerbations drove the direct healthcare cost. Less than one quarter of patients presented claims for pulmonary function tests. CONCLUSIONS COPD imposes a substantial burden on healthcare systems, mainly attributable to the type and occurrence of E-COPD, or in other words, to the exacerbator phenotypes. A more tailored approach to the management of COPD patients is required.
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Affiliation(s)
- Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Cesana
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Sara Conti
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Virginio Chiodini
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Stefano Aliberti
- Department of Health Sciences, University of Milano – Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy
| | - Carla Fornari
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
| | - Lorenzo Giovanni Mantovani
- CESP, Research Centre on Public Health, Department of Statistics and Quantitative Methods, University of Milano – Bicocca, Monza, Italy
- University of Napoli Federico II, Naples, Italy
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Roche N, Small M, Broomfield S, Higgins V, Pollard R. Real World COPD: Association of Morning Symptoms with Clinical and Patient Reported Outcomes. COPD 2013; 10:679-86. [DOI: 10.3109/15412555.2013.844784] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nicolas Roche
- 1Hôpital Cochin–Site Val de Grâce, Université Paris-Descartes, Service de Pneumologie et Réanimation,
Paris, France
| | - Mark Small
- 2Adelphi Real World,
Macclesfield, United Kingdom
| | | | | | - Ryan Pollard
- 2Adelphi Real World,
Macclesfield, United Kingdom
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Guideline adherence in management of stable chronic obstructive pulmonary disease. Respir Med 2013; 107:1046-52. [PMID: 23639271 DOI: 10.1016/j.rmed.2013.04.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/29/2013] [Accepted: 04/02/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the only leading cause of death with rising morbidity and mortality. Clinical practice guidelines (CPGs) to optimize pharmacotherapy for patients with COPD have been updated based on promising results of randomized clinical trials. We examined the frequency of and factors associated with guideline adherence by physicians in clinical practice at an academic medical center. METHODS Patients with a clinical diagnosis of COPD, confirmed by spirometry, who presented to the ambulatory clinics, were enrolled. The primary outcome was provider's adherence to the 2007 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Subjects were categorized as guideline-concordant who received a rescue inhaler (all patients), or at least one long-acting bronchodilator (stage II), or at least one long-acting bronchodilator plus an inhaled corticosteroid (stage III-IV). Demographics, clinical information and type of provider were recorded. Provider type was classified as primary care physician (PCP), pulmonologist, or co-management by both. RESULTS Among 450 subjects who met study criteria, 246 (54.7%) received guideline-concordant treatment. Age, sex, race, disease severity, and co-morbidities were not associated with guideline adherence. Multivariate analysis showed that patients co-managed by a PCP and pulmonologist had a higher likelihood of receiving guideline-concordant treatment than those managed by one or the other (Odds Ratio: 4.59; 95% Confidence Interval: 2.92, 7.22, p < 0.001). CONCLUSIONS Just over half of stable COPD patients receive guideline-concordant care. Co-management by a PCP and pulmonologist increases the likelihood of receiving guideline-concordant inhaler therapy.
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