title: Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids.
abstract: BACKGROUND
  To estimate the potential cost savings by following the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendations in patients being treated for chronic obstructive pulmonary disease (COPD) with the combination of long-acting β(2)-agonist (LABA), long-acting muscarinic antagonist (LAMA) or inhaled corticosteroids (ICS).
  
  
  METHODS
  The Geisinger Health System (GHS) database was utilized to identify subjects between January 1, 2004 to March 12, 2007. The index date was based on the first prescription of a LAMA plus LABA, LAMA plus LABA/ICS, or LABA plus ICS. Patients were included in the study if they: had a COPD diagnosis; had data representative of treatment 12 months prior to and 12 months post index date; were 40 years of age or over; had no prior diagnosis for asthma; and had pulmonary function test (PFT) data. We examined the baseline characteristics of these patients along with their healthcare resource utilization. Based on PFT data within 30 days of the index date, a subgroup was classified as adhering or non-adhering to GOLD guidelines.
  
  
  RESULTS
  A total of 364 subjects could be classified as adhering or non-adherent to current GOLD guidelines based on their PFT results. The adherent subgroup received COPD medications consistent with current GOLD guidelines. Of the LAMA plus LABA cohort, 25 patients adhered and 39 patients were non-adherent to current GOLD guidelines. In the cohort of LABA plus ICS, 74 patients were adherent and 180 patients non-adherent to current GOLD guidelines. In the cohort of LAMA plus LABA/ICS, 21 patients were adherent and 25 patients non-adherent to current GOLD guidelines. GOLD adherence was associated with mean total cost of all services savings of $5,889 for LAMA plus LABA, $3,330 for LABA + ICS, and $10,217 for LAMA plus LABA/ICS cohorts.
  
  
  CONCLUSIONS
  Staging of COPD with a PFT and adherence to current GOLD guidelines was associated with lower costs in subjects with moderate to severe COPD. Appropriate use of LAMA plus LABA, LABA plus ICS, and LAMA plus LABA/ICS has economic as well as clinical benefits for patients and payers.
authors.affiliation: Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA. cva@uic.edu
authors.forename: Carl Victor
authors.initials: CV
authors.lastname: Asche
authors.forename: Shelah
authors.initials: S
authors.lastname: Leader
authors.forename: Craig
authors.initials: C
authors.lastname: Plauschinat
authors.forename: Swetha
authors.initials: S
authors.lastname: Raparla
authors.forename: Ming
authors.initials: M
authors.lastname: Yan
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Ye
authors.forename: Dave
authors.initials: D
authors.lastname: Young
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017046:Cost Savings; D016208:Databases, Factual; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D018803:Models, Economic; D018727:Muscarinic Antagonists / Q000191:economics / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists