title: Variation in adherence with Global Initiative for Chronic Obstructive Lung Disease (GOLD) drug therapy guidelines: a retrospective actuarial claims data analysis.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) is an irreversible and often progressive disease that requires lifelong adherence to complicated drug therapy regimens. The well established Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend specific drug therapy protocols, yet patient adherence to drug therapy and physician adherence to prescribing guidelines is reported to be suboptimal. In this claims based analysis of COPD patients, drug therapy treatment patterns including inhaled corticosteroids and long acting bronchodilator use were evaluated by COPD severity level.
  
  
  METHODS
  A cohort of patients with COPD (without co-existing asthma) was identified in Thomas Reuters MarketScan Commercial Database 2007 (diagnosis codes 491.xx, 492.xx, 496.xx). Using one year (2007) of claims data, a COPD severity risk score was calculated for each patient using established claim logic. Severity levels of mild, moderate, severe, and very severe were established to mimic the GOLD severity levels. Each patient's claim experience was examined for inhaled corticosteroid and long acting bronchodilator use for compliance with GOLD guidelines.
  
  
  RESULTS
  Prevalence of COPD (without co-existing asthma) was 0.7% (44,366 cases). The distribution of COPD subjects into claim based severity levels was 30% mild, 53% moderate, 14% severe and 3% very severe. Claims for inhaled corticosteroid therapy were identified for 8% of mild and 19% of moderate COPD patients; claims for short acting bronchodilator therapy without concomitant use of long acting bronchodilators were identified for 20% of moderate, 14% of severe and 8% of very severe COPD patients; and claims for single long acting bronchodilator therapy in combination with inhaled corticosteroid therapy were identified for 12% of moderate, 19% of severe and 2% of very severe COPD patients.
  
  
  CONCLUSIONS
  This analysis suggests less than optimal compliance with recommended drug therapy treatment for COPD patients based on GOLD guidelines. This study further suggests the utility of claims data analyses for providing reasonable aggregate distributions of COPD severity which allows for health plans and disease management programs to stratify COPD patients by severity level and examine opportunities for improved drug therapy management. Study findings should be considered in the context of the study limitations.
authors: Milliman, Inc., New York, NY, USA. kate.fitch@milliman.com
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