December 21, 2018
When triple therapy is not reserved for higher-risk patients with chronic obstructive pulmonary disease (COPD), risk of adverse events as well as costs rise, according to a study abstract in the Journal of Managed Care & Specialty Pharmacy.
“Guidelines recommend that treatment with a long-acting beta agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS)—ie, triple therapy—is reserved for a select group of symptomatic patients with COPD who continue to exacerbate despite treatment with dual therapy (LABA/LAMA),” researchers wrote. “Evidence suggests that fixed-dose and free combination triple therapy is overprescribed in clinical practice, placing patients at unnecessary risk of adverse events associated with an ICS.”
Researchers assessed the cost and outcomes of triple therapy compared with dual therapy in patients with severe to very-severe symptomatic COPD with a history of exacerbations. Their model used data from a recent triple therapy clinical trial that measured efficacy (moderate and severe exacerbation events) and adverse events (pneumonia). Mean annual costs and mean cost per exacerbation avoided were calculated for the population as a whole as well as by phenotypic subgroups, based on low and high eosinophil counts and prior exacerbation frequency.
In the overall population as well as in every subgroup, mean annual costs were higher with triple therapy, researchers reported. Depending on the subgroup, the percentage difference in mean annual costs with triple therapy compared with dual therapy ranged from 5% to 20%.
Cost per exacerbation saved was less favorable for triple therapy compared with dual therapy in lower subgroups compared with higher subgroups, according to study findings. Between lower ($16,200) and higher ($1900) eosinophil count subgroups, the difference was more than 8-fold.
“The use of fixed-dose and free combination triple therapy in patient populations outside of those recommended in guidelines may unnecessarily increase the risks and costs of COPD treatment,” researchers wrote. “Decision making on the use of triple therapy should consider the impact of patient phenotypes on cost and outcomes.”
The study, which was sponsored by Boehringer Ingelheim, was presented at AMCP Nexus 2018.
Langham S, Wright A, Baldwin M. Costs and outcomes of single-inhaler triple therapy compared to dual therapy with a long-acting beta agonist and long-acting muscarinic antagonist for the treatment of patients with chronic obstructive pulmonary disease in the United States. Journal of Managed Care & Specialty Pharmacy. 2018;24(10-a):S70.
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