In COPD, Across-the-Board Adherence Is Most Effective

Tiotropium, a once-daily inhaled long-acting anticholinergic bronchodilator, provides airflow improvement for at least 24 hours in chronic obstructive pulmonary disease (COPD) patients. Its use has been linked to fewer exacerbations, less dyspnea, and improved quality of life.

Researchers at Ben-Gurion University in Israel set out to examine whether adherence to tiotropium decreases health care utilization overall. Their study was published online ahead of print on December 16, 2014, in Respirology.

The researchers used an academic pulmonology institute’s computerized medical database to identify patients with COPD who initiated tiotropium 18 mg between 2008 and 2011. They enrolled 193 eligible patients. Researchers calculated adherence using the proportion of days covered. They also analyzed adherence to long-acting beta-agonists (LABAs) and/or inhaled corticosteroids (ICSs) at 1 year before and 2 years after tiotropium initiation, and calculated health care utilization costs.

As would be expected in a population of COPD patients, median age was 67 years and 80% were male.

Of the study population, 41% used their tiotropium as prescribed more than 80% of the time, which the researchers identified as the threshold for adherence. This proportion is similar to adherence rates documented in the United States.

Hospitalization costs decreased 1 year following initiation of treatment with tiotropium only when patients’ adherence to LABAs and/or ICSs also improved. The cost savings were sustained in this group through the second year. Total health care utilization costs for patients adherent to tiotropium did not change significantly following initiation of therapy. Reductions in hospitalization costs among the adherent patients were offset by increased medication costs and visits to specialists.

The researchers note that combining long-acting bronchodilators and ICSs is clinically effective. They indicate that to understand tiotropium’s true impact on COPD health care costs, researchers need to look at its use in real world settings and as part of combined therapy frequently prescribed in clinical practice rather than as monotherapy. They suggest more study is needed to determine why patients are nonadherent to their COPD medications.