chronic obstructive pulmonary disease (copd)-related outcomes and costs for patients on combination fluticasone propionate-salmeterol xinafoate 250/50mcg versus anticholinergics in a copd-comorbid depression/anxiety population

Conditions: Pulmonary Disease, Chronic Obstructive

Summary: the objective of this study was to examine copd-related outcomes for patients with comorbid depression/anxiety who are on combination fluticasone propionate/salmeterol xinafoate compared to those receiving anticholinergics. the prevalence of comorbid depression/anxiety in patients with chronic obstructive pulmonary disease (copd) is estimated to be high and range from 10-40%, given that the risk of depression/anxiety symptoms is almost 3 times higher in patients with versus without copd. additionally, patients with comorbid copd and depression/anxiety have higher copd-related healthcare utilization and costs compared to those without depression/anxiety. therapy with maintenance medications for copd has been recommended to prevent future adverse copd outcomes, but the impact of initiating these interventions has not yet been evaluated in a higher-risk population with comorbid copd-depression/anxiety. the present study compares the risk of copd exacerbations and copd-related costs in patients initiating maintenance medications for treatment of copd in a comorbid copd/depression-anxiety population. maintenance medications include inhaled corticosteroid (ics), long-acting beta agonist (laba), combination drug product of ics+laba, and anti-cholinergics (ac) including tiotropium (tio) and ipratropium or combination ipratropium-albuterol (collectively abbreviated as ipr).

this was a retrospective cohort study using a large administrative database (study period: 1/1/2003 through 6/30/2009). date of first fsc or acs (tiotropium; ipratropium alone or in combination with albuterol) was defined as the index date. managed care enrollees (aged \>40 years) having at least one medical claim with a primary diagnosis of copd (icd code 491.xx, 492.xx and 496.xx) and a diagnosis of depression (at least one claim with depression/anxiety or at least one prescription claim for depression/anxiety) in one-year pre-index and within 60-days post-index were defined in the comorbid population. patients were continuously eligible throughout the one-year pre and post-index periods. negative binomial models were used to analyze number of copd-related events \[hospitalization (ip), emergency department (ed), office visits with oral steroid and/or antibiotic prescription within 5 days (ov+rx)\] and logistic regression was used to examine risk of copd events between the two cohorts. copd-related costs were compared between the two cohorts using - generalized linear model with log-link/gamma distribution after adjusting for baseline differences. specifically the study hypothesis for the primary outcome being tested was: ho: there is no difference in risk of any copd-related exacerbation between fsc and ac cohorts ha: there is a difference in risk of any copd-related exacerbation between fsc and ac cohorts hypothesis for the key secondary outcome of copd-related costs that was tested was: ho: there is no difference in copd-related costs between fsc and ac cohorts ha: there is a difference in copd-related costs between fsc and ac cohorts

Eligibility criteria:
inclusion criteria: * diagnosis of copd in any field in the pre-index period and 60 days after the index date * diagnosis of depression/anxiety in any field and a medication for treating depression/anxiety in the pre-index period and 60 days after the index date * index date occurs during identification period * patients must be continuously eligible during 1-year pre and 1-year post-index date and be of at least 40 years of age exclusion criteria: * comorbid conditions (respiratory cancer, cystic fibrosis, fibrosis due to tuberculosis, and bronchiectasis, pneumonociosis, pulmonary fibrosis, pulmonary tuberculosis, sarcoidosis) during the 1 year pre or post-index periods * no other maintenance medications other than the index medication on or 60 days after the index date