The impact of fluticasone furoate/vilanterol on healthcare resource utilisation in the Salford Lung Study in chronic obstructive pulmonary disease

Nawar Diar Bakerly, Dominy Browning, Isabelle Boucot, Jodie Crawford, Sheila McCorkindale, Norman Stein, John P New, Nawar Diar Bakerly, Dominy Browning, Isabelle Boucot, Jodie Crawford, Sheila McCorkindale, Norman Stein, John P New

Abstract

Aim: The Salford Lung Study (SLS) in chronic obstructive pulmonary disease (COPD) was a randomised controlled trial evaluating the effectiveness and safety of initiating fluticasone furoate/vilanterol (FF/VI) 100/25 µg versus continuing usual care (UC) in patients with COPD and a history of exacerbations. Here, we investigate the impact of initiating FF/VI on healthcare resource utilisation (HRU) in SLS COPD.

Methods: HRU and interventions were determined from patients' electronic health records. Annual rates of on-treatment all-cause and COPD-related secondary care contacts (SCCs) and primary care contacts (PCCs) for FF/VI versus UC were analysed using a general linear model. Costs were derived from national data sources.

Results: Least-squares (LS) mean annual rates of all-cause (9.81 versus 9.36) and COPD-related (1.57 versus 1.48) SCCs were similar for FF/VI and UC, as were rates of all-cause hospitalisations (0.87 versus 0.82). Mean duration of hospital stay/patient was 4.5 and 4.2 days, respectively. COPD-related SCC mean total cost/patient was £484 FF/VI and £475 UC. LS mean annual rates of all-cause PCCs were significantly higher for FF/VI (21.20 versus 18.88 UC; p < 0.001). LS mean annual rates of COPD-related PCCs were similar for FF/VI and UC (2.42 versus 2.46). All-cause PCC mean total cost/patient was £900 FF/VI versus £811 UC, but COPD-related PCC costs were similar (£116 versus £114). Direct COPD-related total medical costs/patient were significantly lower for FF/VI (LS geometric mean £806 versus £963 UC; p < 0.001).

Discussion: In patients with COPD and exacerbation history, FF/VI may represent a less costly alternative to current therapies.GlaxoSmithKline plc. study HZC115151; ClinicalTrials.gov NCT01551758.The reviews of this paper are available via the supplemental material section.

Keywords: COPD; effectiveness; fluticasone furoate; healthcare resource utilisation; usual care; vilanterol.

Conflict of interest statement

Conflict of interest statement: NDB is employed by the organisation that provided IT support for automated data collection in SLS COPD (NorthWest EHealth) and received financial support to attend meetings in the form of nonrestricting educational grants from GlaxoSmithKline plc., Novartis, AstraZeneca, and Boehringer Ingelheim. DB, IB, and JC are employed by, and have stock/share ownership in, GlaxoSmithKline plc. SM is a primary care advisor and member of the study governance board for the SLS and an advisory board member for GlaxoSmithKline plc. NS is employed by NorthWest EHealth, partly funded by a grant from GlaxoSmithKline plc. for the SLS. JPN received grants from GlaxoSmithKline plc. and is employed by the organisation that provided IT support for automated data collection in SLS COPD (NorthWest EHealth).

Figures

Figure 1.
Figure 1.
Frequency of on-treatment all-cause PCCs (a) and COPD-related PCCs (b) by study week (ITT population)a. aUsing a revised categorisation of healthcare professional seen and exclusion of study-related Read codes (post hoc analysis). COPD, chronic obstructive pulmonary disease; FF/VI, fluticasone furoate/vilanterol; ITT, intent-to-treat; PCC, primary care contact; UC, usual care.

References

    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease. 2020. report, (accessed 19 February 2020).
    1. Herland K, Akselsen JP, Skjønsberg OH, et al.. How representative are clinical study patients with asthma or COPD for a larger “real life” population of patients with obstructive lung disease? Respir Med 2005; 99: 11–19.
    1. Travers J, Marsh S, Caldwell B, et al.. External validity of randomized controlled trials in COPD. Respir Med 2007; 101: 1313–1320.
    1. Walker S, Fingleton J, Weatherall M, et al.. Limited generalisability of UPLIFT findings to clinical practice. Thorax 2013; 68: 1066–1067.
    1. Scichilone N, Basile M, Battaglia S, et al.. What proportion of chronic obstructive pulmonary disease outpatients is eligible for inclusion in randomized clinical trials? Respiration 2014; 87: 11–17.
    1. Halpin DM, Kerkhof M, Soriano JB, et al.. Eligibility of real-life patients with COPD for inclusion in trials of inhaled long-acting bronchodilator therapy. Respir Res 2016; 17: 120.
    1. Woodcock A, Boucot I, Leather DA, et al.. Effectiveness versus efficacy trials in COPD: how study design influences outcomes and applicability. Eur Respir J 2018; 51: 1701531.
    1. Treweek S, Zwarenstein M. Making trials matter: pragmatic and explanatory trials and the problem of applicability. Trials 2009; 10: 37.
    1. Chalkidou K, Tunis S, Whicher D, et al.. The role for pragmatic randomized controlled trials (pRCTs) in comparative effectiveness research. Clin Trials 2012; 9: 436–446.
    1. Vestbo J, Leather D, Diar Bakerly N, et al.. Effectiveness of fluticasone furoate-vilanterol for COPD in clinical practice. N Engl J Med 2016; 375: 1253–1260.
    1. Bakerly ND, Woodcock A, New JP, et al.. The Salford Lung Study protocol: a pragmatic, randomised phase III real-world effectiveness trial in chronic obstructive pulmonary disease. Respir Res 2015; 16: 101.
    1. New JP, Bakerly ND, Leather D, et al.. Obtaining real-world evidence: the Salford Lung Study. Thorax 2014; 69: 1152–1154.
    1. World Health Organization. International statistical classification of diseases and related health problems 10th revision. 2010. ed, (accessed 13 May 2019).
    1. Curtis L, Burns A. Unit costs of health and social care 2015. Personal Social Services Research Unit, University of Kent, Canterbury, (2015, accessed 13 May 2019).
    1. Monthly Index of Medical Specialities. November 2015, (accessed 13 May 2019).
    1. . NHS reference costs 2014 to 2015, (accessed 13 May 2019).
    1. NHS England Publications Gateway Reference 00883. 2014/2015 national tariff payment system. Annex 5A: national prices, (accessed 13 May 2019).
    1. Woodcock A, Vestbo J, Bakerly ND, et al.. Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial. Lancet 2017; 390: 2247–2255.
    1. Weber J. Epidemiology of adverse reactions to nonsteroidal anti-inflammatory drugs. Adv Inflamm Res 1984; 6: 1–7.
    1. Calderon-Larranaga A, Carney L, Soljak M, et al.. Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study. Thorax 2011; 66: 191–196.
    1. Crisafulli E, Costi S, Luppi F, et al.. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax 2008; 63: 487–492.
    1. Dalal AA, Shah M, Lunacsek O, et al.. Clinical and economic burden of patients diagnosed with COPD with comorbid cardiovascular disease. Respir Med 2011; 105: 1516–1522.
    1. Huiart L, Ernst P, Suissa S. Cardiovascular morbidity and mortality in COPD. Chest 2005; 128: 2640–2646.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren