The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

RELATIONSHIP BETWEEN DAILY DOSING FREQUENCY, COMPLIANCE, HEALTHCARE RESOURCE USE, AND COSTS: EVIDENCE FROM THE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Edmond L. Toy1, Nicolas U. Beaulieu2, Joshua M. McHale2, Timothy R. Welland1, Craig A. Plauschinat3, Andrine Swensen3, Mei Sheng Duh2; 1Analysis Group, Lakewood, CO; 2Analysis Group, Boston, MA; 3Novartis Pharmaceuticals Corporation, East Hanover, NJ

Background: Medication compliance has been shown to have a significant effect on healthcare resource use and associated costs. This study assessed the relationship between the daily dosing frequency (DDF) of COPD pharmacotherapies and treatment compliance and estimated the effect of compliance on healthcare resource use and costs. Methods: COPD patients were identified (ICD-9 491, 492, 493.2, and 496) using a health insurance claims database covering 8 million lives (1999-2006). Patients were stratified based on the recommended DDF (QD, BID, TID, QID) of their first COPD drug claim (index date) post COPD diagnosis. Continuous enrollment was required for 6 months prior to and 12 months after the index date. Compliance was measured using proportion of days covered (PDC). Healthcare resource use outcomes included inpatient days and medical visits (inpatient, outpatient, and emergency room). A multivariate regression model assessed the relationship between compliance and one-year healthcare resource use controlling for demographics, comorbidities, and baseline resource use. Unit health care costs were obtained from the 2005 Medical Expenditure Panel Survey data and adjusted to 2008 dollars using medical CPI data. The total costs were modeled by multiplying the unit costs by the healthcare resource use observed in the study. Results: Sample sizes ranged from 3,678 (QD) to 25,011 (BID). Compliance was strongly correlated with dosing frequency: PDC for QD, BID, TID, and QID patients were 43%, 37%, 30%, and 23%, respectively (all p<0.001 vs. QD). Multivariate analysis showed that one-year compliance was strongly correlated with healthcare resource use. For 1,000 COPD patients, a 5 percentage point increase in PDC reduced the number of inpatient visits by 33, hospital inpatient days by 186 days, and emergency room visits by 15; the estimated number of outpatient visits increased by 29 (p<0.001 for all comparisons). This increase in compliance yielded substantial cost savings from decreased healthcare resource use (see Table 1). Conclusion: COPD patients who initiated treatment with QD dosing had significantly higher compliance than those with more frequent dosings. Patients with higher compliance were found to incur fewer hospital- and emergency room-related visits. For a hypothetical cohort of 1,000 COPD patients, cost savings from increasing PDC (compliance) by 5 percentage points amount to about $300,000 per year, mostly from reduced hospital visits. Sponsored Research - Novartis Pharmaceuticals Corporation, East Hanover, NJ

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