ABSTRACT
BACKGROUND: Increasing availability of therapeutic options for COPD may drive new treatment pathways. This study describes COPD treatment in France, focusing on identifying initial treatment modifications in patients with COPD who either initiated long-acting bronchodilator (LABD)-based therapy or escalated to triple therapy (long-acting muscarinic antagonist [LAMA] + long-acting ß2-agonist [LABA] + inhaled corticosteroid [ICS]). METHODS: This retrospective analysis of patients with COPD in a large general practitioner database (IQVIA Longitudinal Patient Database) in France included two cohorts: Cohort 1 - new initiators of LABD-based therapy (LAMA, LABA, LAMA + LABA, LAMA + ICS, LABA + ICS or LAMA + LABA + ICS); Cohort 2 - patients escalating to triple therapy from mono- or dual-bronchodilator-based maintenance treatment. Both cohorts were indexed on the date of initiation/escalation (January 2008-December 2013), and the first treatment modification (at class level) within the 18-month post-index observational period was described. Five mutually exclusive outcomes were defined: continuous use (no modification), discontinuation (permanent [≥91 days with no restart] or temporary [≥91 days with subsequent restart]), switch, and augmentation (Cohort 1 only). Exploratory analysis of Cohort 1 explored potential drivers of treatment initiation. RESULTS: Overall, 5,065 patients initiated LABD-based therapy (Cohort 1), and 501 escalated to triple therapy (Cohort 2). In Cohort 1, 7.0% of patients were continuous users, 46.5% discontinued permanently, 28.5% discontinued temporarily, 2.8% augmented (added LAMA and/or LABA and/or ICS), and 15.2% switched therapy. In Cohort 2, 18.2% of patients were continuous users, 7.2% discontinued permanently, 27.9% discontinued temporarily, and 46.7% switched therapy. Exploratory analyses showed that time since COPD diagnosis was first recorded, pre-index exacerbation events, and concomitant medical conditions were potential drivers of initial maintenance treatment choices. CONCLUSION: Discontinuation among new initiators of LABD-based therapy was high in France, whereas few switched or augmented treatment. In comparison, permanent discontinuation within 18 months was low in patients escalating to triple therapy.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-2 Receptor Agonists/administration & dosage , Bronchodilator Agents/administration & dosage , Critical Pathways , Electronic Health Records , General Practitioners , Lung/drug effects , Muscarinic Antagonists/administration & dosage , Practice Patterns, Physicians' , Pulmonary Disease, Chronic Obstructive/drug therapy , Administration, Inhalation , Adrenal Cortex Hormones/adverse effects , Adrenergic beta-2 Receptor Agonists/adverse effects , Adult , Aged , Bronchodilator Agents/adverse effects , Clinical Decision-Making , Databases, Factual , Drug Combinations , Drug Substitution , Drug Therapy, Combination , Female , France , Humans , Lung/physiopathology , Male , Middle Aged , Muscarinic Antagonists/adverse effects , Nebulizers and Vaporizers , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: Neuropathic pain (NP) is often severe and represents a major humanistic and economic burden. This study aimed at providing insight on this burden across France, Germany, Italy, Spain, and the UK, considering direct and indirect costs, productivity loss, and humanistic impact on patients and their families. METHODS: Physician questionnaires provided data on patients presenting with NP covering demographics, sick leave and retirement, number of consultations, drug treatments, and surgical procedures. Patients provided further demographic and disease-related data and completed the Work Productivity and Activity Impairment (WPAI), the EuroQol 5-Dimension (EQ-5D), and the Brief Pain Inventory (BPI) questionnaires. All health-related direct unitary costs were collected from relevant country-specific sources and adjusted to 2012 prices () where necessary. A subgroup analysis of costs based on diabetic peripheral neuropathy (n=894), fibromyalgia (n=300), and low back pain (n=963) was performed. FINDINGS: About 413 physicians completed a total of 3,956 patient records forms. Total annual direct health-care costs per patient ranged from 1,939 (Italy) to 3,131 (Spain). Annual professional caregiver costs ranged from 393 (France) to 1,242 (UK), but this only represented a small proportion of total care because much care is provided by family or friends. Sick leave costs ranged from 5,492 (UK) to 7,098 (France), with 10%-32% patients prevented from working at some point by NP. Total cost (including direct and indirect costs) of NP per patient was 10,313 in France (69% of the total cost), 14,446 in Germany (78%), 9,305 in Italy (69%), 10,597 in Spain (67%), and 9,685 in the UK (57%). Indirect costs (ie, sick leave) constituted the majority of costs in all five countries: 7,098 in France, 11,232 in Germany, 6,382 in Italy, 7,066 in Spain, and 5,492 in the UK. In the subgroup analysis, total annual direct costs per patient were highest for neuropathic back pain and radiculopathy, and lowest for fibromyalgia. Mean WPAI score range was 34.4-56.1; BPI interference was 4.1-4.8; and EQ-5D was 0.57-0.74. The results suggest that a significant proportion of the patient's work time in the previous week was affected by NP, and these are relatively high compared with other diseases such as diabetes, respiratory conditions, and arthritis. IMPLICATIONS: Despite differences in practice between countries, these findings suggest a high opportunity cost for society in terms of lost work and productivity due to NP. The wider costs appear significantly higher to patients, carers/families, and society as a whole than to the health system alone.
