Chronic Obstructive Pulmonary Disease•

Outcomes of patients with COPD switching from multiple-inhaler to once-daily single-inhaler triple therapy in a real-world primary care setting in England: a retrospective pre-post cohort study

Abstract

Background Compared with multiple-inhaler triple therapy (MITT), single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) demonstrated improved lung function and meaningful improvements in chronic obstructive pulmonary disease (COPD) Assessment Test score. This real-world study compared the effectiveness of switching patients with COPD in England from MITT to once-daily SITT with FF/UMEC/VI by evaluating rates of COPD exacerbation, healthcare resource use (HCRU) and associated direct medical costs.

Methods Retrospective cohort pre-post study using linked primary care electronic health record and secondary care administrative datasets. Patients diagnosed with COPD at age ≥35 years, with smoking history, linkage to secondary care data and continuous GP registration for 12 months pre-switch and 6 months post-switch to FF/UMEC/VI were included. Index date was the first initiation of an FF/UMEC/VI prescription immediately following MITT use from 15 November 2017 to 30 September 2019. Baseline was 12 months prior to index, with outcomes assessed 6/12 months pre-switch and post-switch, and stratified by prior COPD exacerbation status.

Results We included 2533 patients (mean [SD] age: 71.1 [9.9] years; 52.1% male). In the 6 months post-switch, there were significant decreases in the proportion of patients experiencing ≥1 moderate-to-severe (36.2%–28.9%), moderate only (24.4%–19.8%) and severe only (15.4%–11.8%) COPD exacerbation (each, p<0.0001) compared with the 6 months pre-switch. As demonstrated by rate ratios, there were significant reductions in exacerbation rates of each severity overall (p<0.01) and among patients with prior exacerbations (p<0.0001). In the same period, there were significant decreases in the rate of each COPD-related HCRU and total COPD-related costs (−24.9%; p<0.0001).

Conclusion Patients with COPD switching from MITT to once-daily SITT with FF/UMEC/VI in a primary care setting had significantly fewer moderate and severe exacerbations, and lower COPD-related HCRU and costs, in the 6 months post-switch compared with the 6 months pre-switch.

What is already known on this topic

  • Real-world evidence suggests that single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) demonstrates increased adherence, improved lung function and clinically meaningful improvements in chronic obstructive pulmonary disease (COPD) Assessment Test score compared with multiple-inhaler triple therapy (MITT).

What this study adds

  • We found that, in a real-world primary care setting, switching patients with COPD from MITT to SITT with FF/UMEC/VI was associated with a significant reduction in the proportion of patients experiencing moderate-to-severe, moderate only and severe only exacerbations over the 6 months post-switch compared with the 6 months pre-switch.

  • Over the same period, there was a significant reduction in the rate of exacerbations of each severity (both overall and among a subgroup of patients with prior exacerbations), the rate of COPD-related healthcare resource use (HCRU; primary care consultations, inpatient stays and Accident and Emergency attendance) and total COPD-related costs.

How this study might affect research, practice or policy

  • The results of this study suggest that patients with COPD who are experiencing exacerbations despite receiving MITT may benefit from switching to SITT with FF/UMEC/VI.

  • Switching patients with COPD from MITT to SITT may result in a reduction in overall COPD-related HCRU and associated financial costs.

Background

The Global Initiative for Chronic Obstructive Lung Disease strategy document recommends inhaled triple therapy (an inhaled corticosteroid [ICS], long-acting β2-agonist [LABA] and long-acting muscarinic antagonist [LAMA]) for patients with advanced chronic obstructive pulmonary disease (COPD) at risk of exacerbation despite dual therapy.1

Fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is a single-inhaler triple therapy (SITT), approved by the European Medicines Agency (EMA) in November 2017 as a once-daily inhaler for long-term maintenance treatment of moderate-to-severe COPD in adult patients.2 Previous real-world studies have demonstrated increased adherence among patients with COPD initiating SITT compared with those initiating multiple-inhaler triple therapy (MITT).3 4 Compared with MITT, SITT with FF/UMEC/VI has also been shown to improve lung function and result in more patients gaining clinically meaningful improvements in COPD Assessment Test score.5 Improved persistence to SITT has also been shown compared with MITT.6 Despite these studies, real-world data on switching from MITT to SITT are lacking, and evaluations of healthcare resource use (HCRU) are limited.7

This real-world study compared the effectiveness of switching patients with COPD in England from MITT to once-daily SITT with FF/UMEC/VI by evaluating rates of COPD exacerbations, HCRU and associated direct medical costs.

Methods

Study design

This was a retrospective pre-post cohort study conducted using linked primary care electronic health record (EHR) data and secondary care administrative data through the Clinical Practice Research Datalink (CPRD) Aurum database and Hospital Episode Statistics (HES) Admitted Patient Care and Accident and Emergency (A&E) datasets, respectively. The index date was the earliest date of a single-inhaler FF/UMEC/VI prescription between 15 November 2017 (approval date for FF/UMEC/VI in the UK) and 30 September 2019, following a period of MITT use (online supplemental figure S1). Demographic and clinical characteristics were assessed in the baseline period prior to index. Minimum required follow-up was 6 months, with outcomes observed across 6 and 12 months.

COPD exacerbation rates, HCRU and associated direct medical costs incurred prior to (while on MITT) and post initiation of single-inhaler FF/UMEC/VI were reported. This was a comparative study with bivariate analysis of COPD exacerbations, HCRU and direct medical costs.

Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Data collection

CPRD Aurum is a longitudinal, representative, anonymised EHR database of primary care interactions in England.8 Over 98% of the population in England is registered to receive primary care through a National Health Service (NHS) general practitioner (GP); >10% of these NHS practices in England contribute data to CPRD Aurum.8 As of October 2022, there were approximately 38 million patients in CPRD Aurum eligible for HES linkage, of whom 14 million were active (still alive and registered with the GP practice).9 CPRD Aurum and HES records are linked on a patient level using an eight-step deterministic linkage approach that employs multiple identifiers, including NHS number, date of birth and postcode.10 Approximately 99% of CPRD Aurum practices have consented to participate in the linkage scheme with HES.8

The HES admitted patient care data capture patient demographics, date and method of hospital admission and discharge, diagnoses, specialists seen and procedures undertaken.11 The HES A&E dataset consists of individual records of patient attendances in A&E in England, including diagnoses and investigations. Linkage allows for a complete overview of the patient healthcare pathway.8

Study population

Patients had to meet the following inclusion criteria: ≥1 diagnosis code for COPD at age ≥35 years12 in the primary care setting at any time in the patient history (SNOMED codes reported in online supplemental table S1); ≥1 observable prescription of single-inhaler FF/UMEC/VI between 15 November 2017 and 30 September 2019 following MITT that did not include any drugs in an Ellipta device (ie, any FF-, UMEC- or VI-containing product); current or former smoker prior to the index date; record linked to HES; and continuously registered with a GP for ≥12 months prior to the index date and ≥6 months after the index date.

Patients were required to have received MITT immediately prior to index: patients had to have concomitantly received prescriptions for two different inhalers that form a triple therapy (ICS/LABA+LAMA or LABA/LAMA+ICS) or three different inhalers (ICS+LAMA+ LABA), and MITT was defined as an overlap in the days of supply of all three triple-therapy components of ≥1 day. There was no minimum required continual use of MITT or FF/UMEC/VI to be included in the main analysis to minimise the risk of confounding by indication; patients switching from MITT to FF/UMEC/VI were included in the analysis with an intention-to-treat approach, regardless of any deviations from their MITT or FF/UMEC/VI therapy.

Patients were excluded if they had: ≥1 diagnosis code for any medical condition incompatible with a COPD diagnosis prior to index (ie, conditions that are related to lung or bronchial developmental anomalies, degenerative processes, pulmonary resection or other significant respiratory disorders that can interfere with clinical COPD diagnosis); or had exposure to single-inhaler FF/UMEC/VI or beclomethasone dipropionate/formoterol fumarate/glycopyrronium bromide in the 12 months prior to index date.

Outcomes

Primary objective: COPD exacerbations

An existing validated algorithm was used to identify recorded events and episodes of COPD exacerbation based on the presence of specific events and codes in the CPRD and HES.13 14 Rate of moderate-to-severe COPD exacerbations (moderate only; severe only; and combined) in the 6 and 12 months pre-switch and post-switch was reported as the rate of moderate-to-severe COPD exacerbations per person-year. The proportion of patients with ≥1 exacerbation and the number of exacerbations pre-switch and post-switch were also assessed. Patients without a COPD exacerbation while on MITT were defined as exacerbation-naïve.

Secondary objectives: HCRU and direct medical costs

The number and rate of all-cause and COPD-related primary care (GP) consultations, hospital admissions and A&E visits were analysed. GP consultations were classified as COPD-related if they had a diagnostic code for COPD and/or a moderate COPD exacerbation, or had a prescription for a respiratory medication on the same day. Diagnostic codes for COPD-related hospital admissions included COPD with acute lower respiratory infection, COPD with acute exacerbation and unspecified acute lower respiratory infection. Any A&E visit with a diagnosis condition of ‘Respiratory conditions’ was classified as COPD-related. Average length of stay (LoS) per admission, cumulative LoS across all admissions per patient and direct healthcare costs were also reported.

Direct healthcare costs for primary care consultations and interactions in a hospital setting were derived using unit costs from the 2020 Personal Social Service Resource Unit15 and application of national tariffs to derived healthcare resource groups, respectively.16 The cost of a medication prescribed in primary care was taken from the NHS Drug Tariff (2019/2020 version).17 Prescriptions for short-acting beta agonists, short-acting muscarinic antagonists, ICS-, LABA- and LAMA-containing medications, methylxanthines and phosphodiesterase-4 inhibitors were classed as COPD-related and reported separately to all-cause prescription costs. The sum of all direct healthcare costs (including inpatient and outpatient stays, A&E attendances, primary care consultations and prescription medications) accumulated within each time period was reported, alongside the sum of all COPD-related direct healthcare costs. The 12-month cost estimates were only calculated among patients with 12-month follow-up data available.

Sensitivity analysis

A sensitivity analysis was performed for the primary objective whereby patients must have had a minimum of 6 months cumulative MITT use pre-switch, and 6 months of cumulative single-inhaler FF/UMEC/VI use post-switch. This differed to the definition used in the primary analysis, where no minimum use was required. Cumulative exposure to single-inhaler FF/UMEC/VI was defined as a gap between two subsequent prescriptions (ie, end date of last supply to start date of subsequent new supply) of ≤60 days.

Data analysis

Bivariate comparisons of the proportion of patients with ≥1 COPD exacerbation were performed using McNemar’s test for the difference between two proportions. Overall rates of COPD exacerbation and all-cause and COPD-related HCRU were calculated as the number of events divided by person-years of observation, and compared pre-switch and post-switch from MITT to FF/UMEC/VI using rate ratios (RRs) and 95% CIs. Bivariate comparisons of all-cause and COPD-related HCRU pre-switch and post-switch were also performed. All-cause and COPD-related direct medical costs were calculated by dividing costs incurred pre-switch and post-switch by person-years of observation. The mean costs prior to and following a switch from MITT to FF/UMEC/VI were compared using paired t-tests.

Results

Study population

A total of 2533 patients with 6 months of follow-up data were included in the study cohort (1603 [63.3%] of whom had 12 months of follow-up data; online supplemental table S2), of whom 1273 (50.3%) were exacerbation-naïve and 1260 (49.7%) had exacerbations prior to index. Mean (SD) age was 71.1 (9.9) years and 52.1% of patients were male. Most patients (86.9%) had ≥1 comorbidity, not including asthma. The most commonly reported comorbidities were depression (47.6%), rheumatoid/osteoarthritis (40.8%) and anxiety (33.3%). In addition, 29.9% of patients had a current diagnosis of asthma. Among patients with exacerbations prior to index, 677 (53.7%) had one exacerbation during baseline, 325 (25.8%) had two exacerbations during baseline and 258 (20.5%) had ≥three exacerbations. Baseline demographic and clinical characteristics are reported in table 1.

Table 1
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Baseline demographic and clinical characteristics

In the full study cohort, the medications most commonly prescribed during the baseline period were ICS-LABA (97.6%) and LAMA (95.7%). Use of COPD-related medications during baseline was similar between patients with and without prior exacerbations (online supplemental figure S2). Prior to SITT initiation, the three most commonly used MITT combinations were fluticasone propionate/salmeterol xinafoate (n=1031), budesonide/formoterol fumarate dihydrate (n=704) and beclometasone dipropionate/formoterol fumarate dihydrate (n=615).

COPD exacerbations

In the 6 months following the switch from MITT to FF/UMEC/VI, there were significant decreases in the proportion of patients experiencing ≥1 moderate-to-severe (36.2%–28.9%), moderate only (24.4%–19.8%) and severe only (15.4%–11.8%) COPD exacerbation compared with the 6 months pre-switch (each, p<0.0001) (figure 1). RRs demonstrated significant reductions in exacerbations (moderate, RR: 0.78, 95% CI 0.70 to 0.86; p<0.0001; severe, RR: 0.81, 95% CI 0.71 to 0.92; p=0.0017; and moderate-to-severe, RR: 0.79, 95% CI 0.73 to 0.86; p<0.0001) following the switch from MITT to FF/UMEC/VI among the full study cohort (figure 2A) and patients with prior COPD exacerbations (moderate, RR: 0.56, 95% CI 0.50 to 0.63; p<0.0001; severe, RR: 0.63, 95% CI 0.55 to 0.73; p<0.0001; and moderate-to-severe, RR: 0.59; 95% CI 0.54 to 0.64; p<0.0001) (figure 2B).

Figure 1
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Figure 1

Proportion of patients with COPD exacerbations in the 6 months pre-switch and post-switch to FF/UMEC/VI. N=2533. COPD, chronic obstructive pulmonary disease; FF, fluticasone furoate; MITT, multiple-inhaler triple therapy; UMEC, umeclidinium; VI, vilanterol.

Figure 2
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Figure 2

COPD exacerbation rate in the 6 months pre-switch and post-switch to FF/UMEC/VI. (A) Full study cohort. (B) Patients with prior COPD exacerbations. N=2533. COPD, chronic obstructive pulmonary disease; FF, fluticasone furoate; MITT, multiple-inhaler triple therapy; RR, rate ratio; UMEC, umeclidinium; VI, vilanterol.

In the 12 months following the switch to FF/UMEC/VI (n=1603), the proportions of patients experiencing moderate-to-severe and moderate COPD exacerbations were significantly reduced (p=0.0003 and p<0.0001, respectively), while the proportion of patients experiencing severe COPD exacerbations was unchanged (online supplemental figure S3). Among patients with prior COPD exacerbations, rates of moderate-to-severe (RR: 0.62, 95% CI 0.57 to 0.67; p<0.0001), moderate (RR: 0.54, 95% CI 0.49 to 0.60; p<0.0001), and severe (RR: 0.77; 95% CI 0.67 to 0.88; p=0.0002) COPD exacerbations were significantly reduced (online supplemental figure S4).

Two subgroup analyses were performed, the first among patients who had an exacerbation within a month prior to switching, and the second by ICS/LABA product used prior to SITT initiation. In the first analysis (n=325), there were significant reductions in the rate of moderate-to-severe (RR: 0.41, 95% CI 0.35 to 0.48; p<0.0001), moderate (RR: 0.40, 95% CI 0.32 to 0.49; p<0.0001) and severe (RR: 0.44, 95% CI 0.34 to 0.56; p<0.0001) COPD exacerbations within the 6 months post-switch (online supplemental figure S5). In the second analysis, the proportion of patients experiencing ≥1 moderate-to-severe exacerbation was reduced among patients who used all devices examined (beclometasone dipropionate/formoterol fumarate dihydrate: 37.2%–30.7%; p=0.0052; budesonide/formoterol fumarate dihydrate: 36.4%–29.7%; p=0.0031; fluticasone propionate/salmeterol xinafoate: 38.6%–30.3%; p<0.0001). RRs for moderate-to-severe exacerbations were significantly reduced for patients on each MITT combination (each, p<0.05) (online supplemental figure S6).

Sensitivity analysis

Among the 1963 patients who had 6 months of cumulative MITT and FF/UMEC/VI use pre-switch and post-switch, respectively, similar results to the main analysis were observed. RRs of 0.73 (95% CI 0.66 to 0.80), 0.73 (95% CI 0.65 to 0.83) and 0.71 (95% CI 0.61 to 0.83) were reported for moderate-to-severe, moderate and severe exacerbations, respectively.

HCRU

In the 6 months following the switch to FF/UMEC/VI, rates of all-cause primary care consultations were significantly reduced (figure 3A). There were no significant changes in the rate of all-cause inpatient stays and A&E attendances for patients switching from MITT to FF/UMEC/VI. The rate of each COPD-related HCRU (primary care consultations, inpatient stays and A&E attendances) was significantly reduced following the switch (figure 3B).

Figure 3
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Figure 3

Rate of HCRU in the 6 months pre-switch and post-switch to FF/UMEC/VI. (A) All-cause. (B) COPD-related. N=2533. A&E, Accident and Emergency; COPD, chronic obstructive pulmonary disease; FF, fluticasone furoate; HCRU, healthcare resource use; MITT, multiple-inhaler triple therapy; RR, rate ratio; UMEC, umeclidinium; VI, vilanterol.

In the 12 months following the switch, rates of all-cause primary care consultations were significantly reduced, while rates of inpatient stays and A&E attendances were increased (online supplemental figure S7A). Rates of COPD-related primary care consultations were also significantly reduced following the switch, while rates of inpatient stays increased significantly, and there was no significant change in A&E attendances (online supplemental figure S7B).

Costs

Mean total all-cause costs were numerically decreased by 2.4% in the 6 months post-switch (p=0.5289) (figure 4). Post-switch, there was a significant decrease in costs associated with all-cause primary care consultations (£268–£250; p<0.0001), a numerical increase in costs associated with all-cause inpatient stays (£985–£1113; p=0.0559) and no change in costs due to A&E attendances.

Figure 4
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Figure 4

All-cause and COPD-related costs in the 6 months pre-switch and post-switch to FF/UMEC/VI. N=2533. *p<0.0001. A&E, Accident and Emergency; COPD, chronic obstructive pulmonary disease; FF, fluticasone furoate; MITT, multiple-inhaler triple therapy; UMEC, umeclidinium; VI, vilanterol.

Mean total COPD-related costs were significantly decreased by 24.9% in the 6 months post-switch (p<0.0001) (figure 4). This was largely driven by the 64.7% (p<0.0001) decrease in prescription medication costs, followed by the 35.2% (p<0.0001) decrease in primary care consultation costs. A&E attendance costs were also significantly reduced from £32 to £22 post-switch (p<0.0001). There was no significant change in costs associated with COPD-related inpatient stays post-switch.

A similar pattern was observed for mean 12-month costs, with significantly increased mean total all-cause costs (p=0.0184) post-switch, largely driven by an increase in inpatient stays (p<0.0001) (online supplemental figure S8). Primary care consultation costs were significantly decreased (p=0.0004), with no change in costs due to A&E attendances. Mean total COPD-related costs numerically decreased from £1640 pre-switch to £1461 post-switch (p=0.0518), largely driven by decreasing prescription medication (p<0.0001) and primary care consultation costs (p<0.0001) (online supplemental figure S8).

HCRU and costs among patients with prior COPD exacerbations

Among patients with prior COPD exacerbations, rates of each type of HCRU (both all-cause and COPD-related) were significantly reduced in the 6 months following the switch to FF/UMEC/VI (online supplemental figure S9). Mean total all-cause costs were significantly reduced in the 6 months post-switch from £2676 to £2293 (p=0.0013) (online supplemental figure S10). Mean total COPD-related costs were also significantly reduced from £1616 to £1102 (p<0.0001) post-switch. All COPD-related costs were significantly decreased (p<0.01) (online supplemental figure S10).

In the 12 months post-switch, there was no significant change in mean total all-cause costs. All-cause consultation costs were significantly reduced, while costs associated with all other resources were similar. Mean total COPD-related costs were significantly reduced from £2592 to £1995 (p<0.0001). All mean COPD-related costs were significantly decreased (p<0.01), with the exception of inpatient stays (online supplemental figure S11).

Discussion

This retrospective cohort study provides data on COPD exacerbations, HCRU and costs at a level not readily available from any other European country. COPD exacerbation rates were significantly reduced in the 6 months following a switch from MITT to FF/UMEC/VI compared with the 6 months pre-switch.

Switching from MITT to SITT is common in the UK.18 Patients may switch for clinical reasons (eg, following an exacerbation), but also for economic reasons. Compared with MITT, SITT with FF/UMEC/VI has been shown to be a cost-effective treatment option for symptomatic patients with COPD who have a history of one or more exacerbations in a UK setting.19

The findings of this study are complementary to the results of the INTREPID trial, which demonstrated significant improvements in health status and lung function in patients using SITT with FF/UMEC/VI versus MITT in routine clinical practice.5 Our results are similar to those reported in the USA by Hanania et al, which reported significant reductions in the rate of moderate and severe COPD exacerbations following a switch from MITT to FF/UMEC/VI.7 It should be noted that the role of self-management education in the post-switch reduction in exacerbations cannot be determined as this was not reported in the database used for this study.

In the analysis of exacerbation outcomes by MITT combination, we observed that the benefit of switching to FF/UMEC/VI was consistently seen, even when patients completely changed their device. Device continuity has been suggested to have important implications on COPD disease control and management;20 however, our results appear to suggest that the benefits of switching to a once-daily easy-to-use device outweigh any issues patients may face when switching devices.

For patients previously exacerbating on MITT, there is a greater clinical benefit of switching to single-inhaler FF/UMEC/VI compared with patients with no prior exacerbations, as indicated by the higher reduction in COPD exacerbation rates at 6 months compared with the full patient cohort. The rate of moderate-to-severe, moderate only and severe only COPD exacerbations decreased comparably, indicating that switching to FF/UMEC/VI had a comparable effect on all COPD exacerbation severities included within this study at 6 months.

This benefit was also seen at 12 months post-switch among patients with prior COPD exacerbations, as evidenced by significantly reduced RRs for moderate-to-severe, moderate only and severe only COPD exacerbations. In addition, the higher RRs for moderate-to-severe and severe only exacerbations at 12 months post-switch compared with 6 months post-switch among patients with prior COPD exacerbations suggests that switching to FF/UMEC/VI may be less effective at reducing COPD exacerbations if the interval from the last exacerbation is more than 6 months. This is supported by the findings of a recent retrospective cohort study, which found that compared with delayed initiation of FF/UMEC/VI following an exacerbation, prompt initiation was associated with fewer subsequent exacerbations.21 These findings could also be explained by the effects of a reduction in adherence to triple therapy over longer time periods, as shown previously by Halpin et al.6 However, further investigation is required as this study did not require patients to be continuously using FF/UMEC/VI post-switch, although the results of the sensitivity analysis (which required 6 months continual MITT use pre-switch and 6 months continual single-inhaler FF/UMEC/VI use post-switch) were similar to those for the overall cohort.

We observed that the clinical benefit of switching from MITT to FF/UMEC/VI was in line with the reduction of COPD-related resource and cost burden observed in the full patient cohort, as well as patients who had COPD exacerbations prior to switching. This is emphasised not only by the comparable reduction in COPD exacerbation rates, COPD resource use and costs in the full patient cohort, but also the increased clinical and economic benefit observed in the subgroup of patients with prior COPD exacerbations on MITT pre-switch.

An increase in all-cause inpatient stays and associated costs at both 6 and 12 months, and in A&E attendances and associated costs at 12 months post-switch, was observed in the entire cohort. A substantial percentage of the cohort had multiple comorbidities. Acute myocardial infarction, congestive heart failure and stroke were relatively common (all experienced by ≥12% of patients). This therefore increases the likelihood that these cost increases were due to secular trends independent of switching to FF/UMEC/VI.

There are several limitations which should be considered. Requiring ≥6 months of follow-up data may have introduced survivorship bias. The indexing period ended on 30 September 2019, and patients were therefore relatively early adopters of FF/UMEC/VI as EMA approval was received in November 2017; however, we required patients to be indexed early to avoid the COVID-19 pandemic period which would have biased results. Regression to the mean is also a potential bias of the pre-post study design.22 The lack of a comparison cohort for patients who did not switch to FF/UMEC/VI meant that some secular trends may not be controlled, for example, increasing all-cause HCRU over time. As is common to retrospective database analyses in COPD, there is the potential for misdiagnosis of COPD as asthma and vice versa, and we cannot know for certain that COPD MITT medications were not prescribed to treat asthma, as they are also indicated. In addition, only medications prescribed in the primary care setting were recorded in the study data used, although it is expected that COPD prescriptions initiated in an alternative care setting (eg, by a specialist) would be continued by a GP.

Conclusions

Switching from MITT to FF/UMEC/VI significantly decreased the rate of COPD exacerbations, COPD-related HCRU and direct medical costs in the 6 months following the switch compared with the 6 months prior. The impact of switching to FF/UMEC/VI is especially evident in patients with prior COPD exacerbations, where significant reductions in all-cause and COPD-related HCRU and direct medical costs were also observed 12 months following the switch from MITT.

Overview

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