Hospital Admission and Readmission Among US Patients Receiving Umeclidinium/Vilanterol or Tiotropium as Initial Maintenance Therapy for Chronic Obstructive Pulmonary Disease

Abstract

Introduction Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are at risk of further readmissions, increased treatment costs, and excess mortality. This study evaluated inpatient admissions and readmissions in patients receiving initial maintenance therapy with umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO). Methods This retrospective, matched cohort study identified patients with COPD who initiated maintenance therapy with UMEC/VI or TIO from Optum’s de-identified Clinformatics Data Mart database between January 1, 2013, and December 31, 2018 (index date defined as earliest dispensing). Eligibility criteria included: ≥ 1 medical claim for COPD pre-index or on the index date; ≥ 12 months of continuous eligibility pre-index; age ≥ 40 years at index; no pre- or post-index asthma diagnosis; and no pre-index claims for medications containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists. Outcomes included time to first on-treatment COPD-related inpatient admission, rate of on-treatment COPD-related admissions, and rate of all-cause and COPD-related readmissions within 30 and 90 days. Propensity score matching was used to adjust for potential confounders. Results Matched UMEC/VI and TIO cohorts each included 7997 patients and were balanced on baseline characteristics (mean age 70.9 years; female 47.1–47.6%). Over 12 months, patients initiating UMEC/VI had significantly reduced risk (hazard ratio [95% CI]: 0.87 [0.79, 0.96]; p = 0.006) and rates (rate ratio [95% CI]: 0.80 [0.72, 0.92]; p = 0.008) of COPD-related inpatient admissions compared with TIO. While all-cause readmission rates were similar between treatment cohorts, readmission rates among patients with an initial admission length of stay of 1–3 days were numerically lower for UMEC/VI versus TIO (30-day readmissions: 10.5% vs. 12.4%; 90-day readmissions: 15.5% vs. 19.8%). Similar patterns were observed for COPD-related readmissions. Conclusions These findings highlight the real-world benefits of dual therapy with UMEC/VI versus TIO in reducing inpatient admissions and readmissions in patients with COPD, which may translate to lower healthcare costs.

Time-to-first exacerbation, adherence, and medical costs among US patients receiving umeclidinium/vilanterol or tiotropium as initial maintenance therapy for chronic obstructive pulmonary disease: a retrospective cohort study

“…Patients were matched 1:1 between the UMEC/VI and TIO cohorts using propensity scores (PS) estimated from a multivariable logistic regression model, as previously described [ 14 ]. Patients were also exact-matched on pre-index COPD-related moderate or severe exacerbations.…”

Inpatient Admissions and Re-Admissions in Medicare Beneficiaries Initiating Umeclidinium/Vilanterol or Tiotropium Therapy

“…A recent retrospective matched cohort study found significantly reduced risk and rates of COPD-related inpatient admissions, as well as a numerically lower proportion of short inpatient stays (1–3 days) at both 30 and 90 days and a 22-day longer mean time-to-first admission, for UMEC/VI versus TIO. 6 While this study was also in a US population, it was not focused specifically on Medicare recipients, which may have contributed to the disparity in findings. The cohorts in this study also had a lower baseline mean rate of exacerbations (0.49–0.5 per year) than those in our study (1.7–2.5 over the 12-month baseline period), which may have also impacted findings.…”

“…The cohorts in this study also had a lower baseline mean rate of exacerbations (0.49–0.5 per year) than those in our study (1.7–2.5 over the 12-month baseline period), which may have also impacted findings. 6 …”

Dual bronchodilation for the treatment of COPD: From bench to bedside

“…Furthermore, umeclidinium/ vilanterol significantly reduced the risk and rates of COPD-related hospitalisations compared to tiotropium. 91 Readmission rates among patients with a first short-term admission (1-3 days) were numerically lower in the umeclidinium/vilanterol cohort than in the tiotropium cohort. In addition, patients who started treatment with umeclidinium/vilanterol were more adherent to therapy and took longer to switch to triple multiple inhaler therapy than those who started treatment with fluticasone propionate/salmeterol.…”

“…In addition, COPD‐related total and pharmacy costs per patient per month were lower and switching or increasing therapy was less frequent than in patients in the monotherapy‐treated cohort. Furthermore, umeclidinium/vilanterol significantly reduced the risk and rates of COPD‐related hospitalisations compared to tiotropium 91 . Readmission rates among patients with a first short‐term admission (1‐3 days) were numerically lower in the umeclidinium/vilanterol cohort than in the tiotropium cohort.…”