title: A US database study characterizing patients initiating a budesonide-formoterol combination versus tiotropium bromide as initial maintenance therapy for chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To compare clinical and demographic characteristics, resource utilization and costs of chronic obstructive pulmonary disease (COPD) patients prior to initiating budesonide-formoterol combination (BFC) or tiotropium-maintenance therapy.
  
  
  METHODS
  This cross-sectional study used claims-based diagnosis to identify COPD patients in the HealthCore Integrated Research Database who initiated BFC or tiotropium therapy between March 1, 2009 and January 31, 2012 (intake period); the index date was defined as the initial prescription fill for either agent. Patients diagnosed with respiratory tract cancer or receiving inhaled corticosteroids/long-acting β2-adrenergic agonists or tiotropium in 12 months prior to index date were excluded. Categorical variables were evaluated with χ(2) tests; mean cost differences were evaluated using γ-regression.
  
  
  RESULTS
  Overall, 6,940 BFC and 10,831 tiotropium patients were identified. The BFC group was younger (mean age 64 versus 67 years), with a greater proportion of females (54% versus 51%). BFC-treated patients had more comorbid respiratory conditions, including asthma (25% versus 13%), but fewer comorbid cardiovascular conditions, including atherosclerosis (7% versus 10%) and myocardial infarction (4% versus 6%). A greater proportion of BFC patients received prior respiratory medication, including oral corticosteroids (46% versus 35%) and short-acting β2-agonists (44% versus 35%). Tiotropium-treated patients had a greater mean number of COPD-related outpatient visits (4.6 versus 4.1). BFC-treated patients had lower total all-cause ($17,259 versus $17,926) and COPD-related ($1,718 versus $1,930) health care costs, driven by lower all-cause and COPD-related inpatient expenditures.
  
  
  CONCLUSIONS
  Initiators of BFC or tiotropium showed differences in clinical and demographic characteristics and health care utilization and costs prior to starting COPD maintenance therapy.
authors: HealthCore Inc., Wilmington, DE, US.
authors: David M
authors: DM
authors: Kern
authors: AstraZeneca, Wilmington, DE, USA.
authors: Setareh A
authors: SA
authors: Williams
authors: HealthCore Inc., Wilmington, DE, US.
authors: Ozgur
authors: O
authors: Tunceli
authors: AstraZeneca, Mölndal, Sweden.
authors: Catrin
authors: C
authors: Wessman
authors: HealthCore Inc., Wilmington, DE, US.
authors: Siting
authors: S
authors: Zhou
authors: AstraZeneca, Wilmington, DE, USA.
authors: Ned
authors: N
authors: Pethick
authors: AstraZeneca, Wilmington, DE, USA.
authors: Hanaa
authors: H
authors: Elhefni
authors: AstraZeneca, Wilmington, DE, USA.
authors: Frank
authors: F
authors: Trudo
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019819:Budesonide / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D057225:Data Mining; D016208:Databases, Factual; D004338:Drug Combinations; D016527:Drug Costs; D004983:Ethanolamines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D000068759:Formoterol Fumarate; D005938:Glucocorticoids / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology; D012602:Scopolamine Derivatives / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012737:Sex Factors; D013997:Time Factors; D000069447:Tiotropium Bromide; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D004338:Drug Combinations; D004983:Ethanolamines; D005938:Glucocorticoids; D012602:Scopolamine Derivatives; D019819:Budesonide; D000068759:Formoterol Fumarate; D000069447:Tiotropium Bromide
keywords: chronic respiratory condition; health care utilization and costs; observational study; outcome research; retrospective analysis