Dual versus triple therapy in patients hospitalized for COPD in France: a claims data study

Faustine Dalon,1 Nicolas Roche,2 Manon Belhassen,1 Maëva Nolin,1 Hervé Pegliasco,3 Gaëtan Deslée,4 Bruno Housset,5 Philippe Devillier,6 Eric Van Ganse1,7–81Pharmacoepidemiology Department, PELyon, Lyon, France; 2Respiratory Medicine, Cochin Hospital, AP-HP and Paris Descartes University (EA2511), Sorbonne Paris Cité, Paris, France; 3Pulmonary Department, European Hospital, Marseille, France; 4Pulmonary Department, INSERM U1250, Maison Blanche University Hospital, Reims, France; 5Pulmonary Department, CHI de Créteil, University Paris Est Créteil, Créteil, France; 6Department of Airway Diseases, UPRES EA 220, Foch Hospital, Paris-Saclay University, Suresnes, France; 7EA 7425 Hesper Health Services and Performance Research, Claude-Bernard University, Lyon, France; 8Respiratory Medicine, Croix-rousse Hospital, Lyon, FranceCorrespondence: Faustine DalonPELyon, 11 Rue Guillaume Paradin, Lyon 69008, FranceTel +33 47 877 1024Fax +33 47 877 8660Email faustine.dalon@univ-lyon1.frPurposes: Following a hospitalization for COPD, dual and triple therapies were compared in terms of persistence and relations with outcomes (exacerbations, health care resource use and costs).Methods: This was a historical observational database study. All patients aged ≥45 hospitalized for COPD between 2007 and 2015 were identified in a 1/97th, random sample of French claims data. Patients receiving dual therapy within 60 days after hospitalization were compared to patients receiving triple therapy, after propensity score matching on disease severity.Results: Of the 3,089 patients hospitalized for COPD, 1,538 (49.8%) received either dual or triple therapy in the 2 months following inclusion, and 1,500 (48.6%) had at least 30 days of follow-up available; 846 (27.4%) received dual therapy, and 654 (21.2%) received triple therapy. After matching, the number of exacerbations was 2.4 per year in the dual vs 2.3 in the triple group (p=0.45). Among newly treated patients (n=206), persistence at 12 months was similar in the dual and triple groups (48% vs 41%, respectively, p=0.37). As compared to patients on dual therapy, more patients on triple therapy received oral corticosteroids (49.1 vs 40.4%, p=0.003) or were hospitalized for any reason (67%vs 55.8%, p=0.0001) or for COPD (35.3 vs 25.1%, p=0.0002) during follow-up. Cost of care was higher for patients on triple than for those on dual therapy (€11,877.1 vs €9,825.1, p=0.01).Conclusion: Following hospitalizations for COPD, patients on dual and triple therapy experienced recurrent exacerbations, limited adherence to therapies and high cost of care. Patients on triple therapy appeared more severe than those on dual therapy, as reflected by exacerbations and health care resource use.Keywords: COPD, therapy, persistence, exacerbations, health care resource use