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Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting.
Int J Chron Obstruct Pulmon Dis. 2016; 11:2749-2755.IJ

Abstract

AIM

The objective of this study was to evaluate the different outcomes associated with the use of budesonide/formoterol compared to fluticasone/salmeterol in fixed combinations in patients with COPD in a "real-world" setting. The outcomes included exacerbation rates and health care costs.

PATIENTS AND METHODS

An observational retrospective cohort analysis, based on administrative databases of three local health units, was conducted. Patients with at least one prescription of fixed-dose combination of inhaled corticosteroids and long-acting β2-agonists (budesonide/formoterol or fluticasone/salmeterol), at dosages and formulations approved for COPD in Italy, between January 1, 2009 and December 31, 2011 (inclusion period), were included. Patients were followed until December 2012, death or end of treatment (follow-up period), whichever occurred first. Patients were included if they were aged ≥40 years and had at least 6 months of follow-up. Propensity score matching was performed to check for confounding effects. Number of hospitalizations for COPD and number of oral corticosteroid and antibiotic prescriptions during follow-up were analyzed using Poisson regression models. The cost analysis was conducted from the perspective of the National Health System.

RESULTS

After matching, 4,680 patients were analyzed, of which 50% were males with a mean age of 64±13 years. In the Poisson regression models, the incidence rate ratio for budesonide/formoterol as compared to fluticasone/salmeterol was 0.84 (95% confidence interval [CI]: 0.74-0.96, P=0.010) for number of hospitalizations, 0.89 (95% CI: 0.87-0.92, P<0.001) for number of oral corticosteroid prescriptions and 0.88 (95% CI: 0.86-0.89, P<0.001) for number of antibiotic prescriptions. The mean annual expenditure for COPD management was €2,436 for patients treated with budesonide/formoterol and €2,784 for patients treated with fluticasone/salmeterol.

CONCLUSION

Among patients with COPD, treatment with a fixed combination of budesonide/formoterol was associated with fewer exacerbations and a lower, but not significant, cost of illness than the treatment with fluticasone/salmeterol. Real-world analyses are requested to ameliorate interventions to address unmet needs, optimizing treatment pathways to improve COPD-related burden and outcomes.

Authors+Show Affiliations

CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

27853362

Citation

Perrone, Valentina, et al. "Comparative Analysis of Budesonide/formoterol and Fluticasone/salmeterol Combinations in COPD Patients: Findings From a Real-world Analysis in an Italian Setting." International Journal of Chronic Obstructive Pulmonary Disease, vol. 11, 2016, pp. 2749-2755.
Perrone V, Sangiorgi D, Buda S, et al. Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting. Int J Chron Obstruct Pulmon Dis. 2016;11:2749-2755.
Perrone, V., Sangiorgi, D., Buda, S., & Degli Esposti, L. (2016). Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting. International Journal of Chronic Obstructive Pulmonary Disease, 11, 2749-2755.
Perrone V, et al. Comparative Analysis of Budesonide/formoterol and Fluticasone/salmeterol Combinations in COPD Patients: Findings From a Real-world Analysis in an Italian Setting. Int J Chron Obstruct Pulmon Dis. 2016;11:2749-2755. PubMed PMID: 27853362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting. AU - Perrone,Valentina, AU - Sangiorgi,Diego, AU - Buda,Stefano, AU - Degli Esposti,Luca, Y1 - 2016/11/04/ PY - 2016/11/18/entrez PY - 2016/11/18/pubmed PY - 2017/8/15/medline KW - COPD KW - budesonide/formoterol KW - exacerbations KW - fluticasone/salmeterol KW - inhaled corticosteroids KW - long-acting β2-agonist SP - 2749 EP - 2755 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 11 N2 - AIM: The objective of this study was to evaluate the different outcomes associated with the use of budesonide/formoterol compared to fluticasone/salmeterol in fixed combinations in patients with COPD in a "real-world" setting. The outcomes included exacerbation rates and health care costs. PATIENTS AND METHODS: An observational retrospective cohort analysis, based on administrative databases of three local health units, was conducted. Patients with at least one prescription of fixed-dose combination of inhaled corticosteroids and long-acting β2-agonists (budesonide/formoterol or fluticasone/salmeterol), at dosages and formulations approved for COPD in Italy, between January 1, 2009 and December 31, 2011 (inclusion period), were included. Patients were followed until December 2012, death or end of treatment (follow-up period), whichever occurred first. Patients were included if they were aged ≥40 years and had at least 6 months of follow-up. Propensity score matching was performed to check for confounding effects. Number of hospitalizations for COPD and number of oral corticosteroid and antibiotic prescriptions during follow-up were analyzed using Poisson regression models. The cost analysis was conducted from the perspective of the National Health System. RESULTS: After matching, 4,680 patients were analyzed, of which 50% were males with a mean age of 64±13 years. In the Poisson regression models, the incidence rate ratio for budesonide/formoterol as compared to fluticasone/salmeterol was 0.84 (95% confidence interval [CI]: 0.74-0.96, P=0.010) for number of hospitalizations, 0.89 (95% CI: 0.87-0.92, P<0.001) for number of oral corticosteroid prescriptions and 0.88 (95% CI: 0.86-0.89, P<0.001) for number of antibiotic prescriptions. The mean annual expenditure for COPD management was €2,436 for patients treated with budesonide/formoterol and €2,784 for patients treated with fluticasone/salmeterol. CONCLUSION: Among patients with COPD, treatment with a fixed combination of budesonide/formoterol was associated with fewer exacerbations and a lower, but not significant, cost of illness than the treatment with fluticasone/salmeterol. Real-world analyses are requested to ameliorate interventions to address unmet needs, optimizing treatment pathways to improve COPD-related burden and outcomes. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/27853362/Comparative_analysis_of_budesonide/formoterol_and_fluticasone/salmeterol_combinations_in_COPD_patients:_findings_from_a_real_world_analysis_in_an_Italian_setting_ L2 - https://dx.doi.org/10.2147/COPD.S114554 DB - PRIME DP - Unbound Medicine ER -