Table 1.
Demographic and clinical characteristics of triple therapy users
| Characteristics | Triple therapy users: ≥1-day overlapa | Triple therapy users: 30-day overlapa | ||||
|---|---|---|---|---|---|---|
| Overall | Two inhalersb | Three inhalersb | Overall | Two inhalersb | Three inhalersb | |
| N=14,635 | N=14,403 | N=232 | N=6,658 | N=6,611 | N=47 | |
| Age (years), mean ± SD (median) | 61.9±8.5 (61.0) | 61.8±8.5 (61.0) | 64.5±8.6 (63.0) | 61.8±8.6 (61.0) | 61.8±8.6 (61.0) | 65.3±8.4 (63.0) |
| Gender, female, n (%) | 6,326 (43.2) | 6,230 (43.3) | 96 (41.4) | 2,853 (42.9) | 2,833 (42.9) | 20 (42.6) |
| Region,c n (%) | ||||||
| Midwest | 4,113 (28.1) | 4,030 (28.0) | 83 (35.8) | 1,895 (28.5) | 1,880 (28.4) | 15 (31.9) |
| South | 5,404 (36.9) | 5,337 (37.1) | 67 (28.9) | 2,543 (38.2) | 2,528 (38.2) | 15 (31.9) |
| West | 1,235 (8.4) | 1,202 (8.3) | 33 (14.2) | 515 (7.7) | 508 (7.7) | 7 (14.9) |
| Northeast | 3,594 (24.6) | 3,547 (24.6) | 47 (20.3) | 1,584 (23.8) | 1,574 (23.8) | 10 (21.3) |
| Unknown | 289 (2.0) | 287 (2.0) | 2 (0.9) | 121 (1.8) | 121 (1.8) | 0 (0.0) |
| Insurance product type,c n (%) | ||||||
| PPO | 10,918 (74.6) | 10,765 (74.7) | 153 (65.9) | 5,130 (77.1) | 5,096 (77.1) | 34 (72.3) |
| HMO | 2,336 (16.0) | 2,286 (15.9) | 50 (21.6) | 896 (13.5) | 888 (13.4) | 8 (17.0) |
| Indemnity/traditional | 618 (4.2) | 599 (4.2) | 19 (8.2) | 289 (4.3) | 286 (4.3) | 3 (6.4) |
| POS | 547 (3.7) | 538 (3.7) | 9 (3.9) | 231 (3.5) | 229 (3.5) | 2 (4.3) |
| CDHP | 80 (0.5) | 79 (0.5) | 1 (0.4) | 36 (0.5) | 36 (0.5) | 0 (0.0) |
| HSA | 5 (0.0) | 5 (0.0) | 0 (0.0) | 1 (0.0) | 1 (0.0) | 0 (0.0) |
| Unknown | 131 (0.9) | 131 (0.9) | 0 (0.0) | 75 (1.1) | 75 (1.1) | 0 (0.0) |
| Year of index date, n (%) | ||||||
| 2012 | 4,678 (32.0) | 4,604 (32.0) | 74 (31.9) | 2,237 (33.6) | 2,220 (33.6) | 17 (36.2) |
| 2013 | 3,924 (26.8) | 3,862 (26.8) | 62 (26.7) | 1,826 (27.4) | 1,815 (27.5) | 11 (23.4) |
| 2014 | 3,406 (23.3) | 3,355 (23.3) | 51 (22.0) | 1,495 (22.5) | 1,485 (22.5) | 10 (21.3) |
| 2015 | 2,627 (18.0) | 2,582 (17.9) | 45 (19.4) | 1,100 (16.5) | 1,091 (16.5) | 9 (19.1) |
| Exacerbations,d n (%) | ||||||
| Any | 8,447 (57.7) | 8,296 (57.6) | 151 (65.1) | 3,529 (53.0) | 3,503 (53.0) | 26 (55.3) |
| Moderate | 7,102 (48.5) | 6,967 (48.4) | 135 (58.2) | 2,830 (42.5) | 2,810 (42.5) | 20 (42.6) |
| Severe | 3,562 (24.3) | 3,483 (24.2) | 79 (34.1) | 1,600 (24.0) | 1,584 (24.0) | 16 (34.0) |
| COPD-related medication use,d n (%) | ||||||
| Maintenance therapies | ||||||
| Any | 11,440 (78.2) | 11,220 (77.9) | 220 (94.8) | 3,549 (53.3) | 3,513 (53.1) | 36 (76.6) |
| LAMA | 6,819 (46.6) | 6,646 (46.1) | 173 (74.6) | 1,903 (28.6) | 1,878 (28.4) | 25 (53.2) |
| ICS/LABA | 6,317 (43.2) | 6,299 (43.7) | 18 (7.8) | 1,924 (28.9) | 1,921 (29.1) | 3 (6.4) |
| ICS | 1,166 (8.0) | 1,026 (7.1) | 140 (60.3) | 430 (6.5) | 409 (6.2) | 21 (44.7) |
| LABA | 334 (2.3) | 206 (1.4) | 128 (55.2) | 99 (1.5) | 80 (1.2) | 19 (40.4) |
| LABA/LAMA | 55 (0.4) | 55 (0.4) | 0 (0.0) | 18 (0.3) | 18 (0.3) | 0 (0.0) |
| Other therapies | ||||||
| Antibiotics | 10,287 (70.3) | 10,120 (70.3) | 167 (72.0) | 4,548 (68.3) | 4,518 (68.3) | 30 (63.8) |
| SABA | 8,880 (60.7) | 8,710 (60.5) | 170 (73.3) | 3,387 (50.9) | 3,362 (50.9) | 25 (53.2) |
| SCS | 7,056 (48.2) | 6,924 (48.1) | 132 (56.9) | 2,942 (44.2) | 2,917 (44.1) | 25 (53.2) |
| SABA/SAMA | 2,879 (19.7) | 2,806 (19.5) | 73 (31.5) | 1,142 (17.2) | 1,136 (17.2) | 6 (12.8) |
| SAMA | 538 (3.7) | 514 (3.6) | 24 (10.3) | 206 (3.1) | 203 (3.1) | 3 (6.4) |
| Phosphodiesterase-4 inhibitor | 219 (1.5) | 205 (1.4) | 14 (6.0) | 76 (1.1) | 74 (1.1) | 2 (4.3) |
| Methylxanthines | 192 (1.3) | 186 (1.3) | 6 (2.6) | 68 (1.0) | 68 (1.0) | 0 (0.0) |
| CCI score,d mean ± SD (median) | 2.36±2.03 (2.00) | 2.36±2.03 (2.00) | 2.54±2.13 (2.00) | 2.35±2.07 (2.00) | 2.35±2.07 (2.00) | 2.47±1.91 (2.00) |
| Key comorbidities from the CCI score,d n (%) | ||||||
| Diabetes, uncomplicated | 2,855 (19.5) | 2,806 (19.5) | 49 (21.1) | 1,347 (20.2) | 1,336 (20.2) | 11 (23.4) |
| Peripheral vascular disorders | 2,138 (14.6) | 2,101 (14.6) | 37 (15.9) | 1,000 (15.0) | 995 (15.1) | 5 (10.6) |
| Congestive heart failure | 2,125 (14.5) | 2,076 (14.4) | 49 (21.1) | 992 (14.9) | 978 (14.8) | 14 (29.8) |
| Key comorbidities from the Elixhauser comorbidity index score,d n (%) | ||||||
| Hypertension, uncomplicated | 8,870 (60.6) | 8,728 (60.6) | 142 (61.2) | 4,039 (60.7) | 4,007 (60.6) | 32 (68.1) |
| Cardiac arrhythmias | 3,019 (20.6) | 2,955 (20.5) | 64 (27.6) | 1,378 (20.7) | 1,362 (20.6) | 16 (34.0) |
| Depression | 2,586 (17.7) | 2,543 (17.7) | 43 (18.5) | 1,124 (16.9) | 1,117 (16.9) | 7 (14.9) |
| Fluid and electrolyte disorders | 2,162 (14.8) | 2,121 (14.7) | 41 (17.7) | 984 (14.8) | 976 (14.8) | 8 (17.0) |
| Hypothyroidism | 1,860 (12.7) | 1,821 (12.6) | 39 (16.8) | 830 (12.5) | 824 (12.5) | 6 (12.8) |
| COPD-related healthcare utilization,d mean ± SD | ||||||
| Hospitalization, n | 1.3±0.8 | 1.3±0.7 | 1.5±1.0 | 1.3±0.7 | 1.3±0.7 | 1.4±0.8 |
| Length of stay, days | 7.4±10.9 | 7.4±10.8 | 8.3±14.5 | 7.5±9.4 | 7.4±9.0 | 12.3±27.9 |
| ER visits, n | 1.4±1.2 | 1.4±1.2 | 1.4±0.8 | 1.4±0.9 | 1.4±0.9 | 1.5±0.8 |
| Outpatient visits, n | 5.5±7.9 | 5.5±7.9 | 9.5±9.5 | 5.1±7.7 | 5.1±7.7 | 7.6±7.5 |
Notes:
a
Triple therapy was defined as an overlap of 1- or 30-day supply of ICS, LABA, and LAMA.
b
Two inhalers included ICS/LABA + LAMA and ICS + LABA/LAMA and three inhalers included ICS + LABA + LAMA. The number of inhalers was determined at the index date.
c
Evaluated at the index date.
d
Evaluated during a 12-month baseline period.
Abbreviations: CCI, Charlson Comorbidity Index (Quan update); CDHP, consumer directed health care; ER, emergency room; HMO, health maintenance organization; HSA, health savings account; ICS, inhaled corticosteroid; LABA, long-acting β2-agonists; LAMA, long-acting muscarinic antagonists; POS, point of service; PPO, preferred provider organization; SABA, short-acting β2-agonists; SAMA, short-acting muscarinic antagonists; SCS, systemic corticosteroids.