Observational study on the impact of initiating tiotropium alone versus tiotropium with fluticasone propionate/salmeterol combination therapy on outcomes and costs in chronic obstructive pulmonary disease

Managed-care enrollees who had an index event of ≥ 1 pharmacy claim for TIO during the study period (January 1, 2003-April 30, 2008) and met other eligibility criteria were categorized into one of two cohorts depending on their medication use. Patients in the TIO+FSC cohort had combination therapy with TIO and FSC, defined as having an FSC claim on the same date as the TIO claim. Patients in the TIO cohort had no such FSC use. The risks of COPD exacerbations and healthcare costs were compared between cohorts during 1 year of follow-up.The sample comprised 3333 patients (n = 852 TIO+FSC cohort, n = 2481 TIO cohort). Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation (hazard ratio 0.772; 95% confidence interval [CI] 0.641, 0.930) and any exacerbation (hazard ratio 0.763; 95% CI 0.646, 0.949) and a nonsignificant reduction in COPD-related adjusted monthly medical costs.Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation and any exacerbation over a follow-up period of up to 1 year. These improvements were gained with triple therapy at roughly equal cost of that of TIO alone.The goals of pharmacologic therapy for chronic obstructive pulmonary disease (COPD)-to control symptoms, improve health status, and reduce the frequency of exacerbations [1]-cannot be met with monotherapy for many patients. Guidelines on COPD management recommend the combined use of long-acting bronchodilators and inhaled corticosteroids to optimize outcomes in patients with inadequate control on monotherapy [1]. Both long-acting bronchodilators (including the anticholinergic tiotropium bromide [TIO] and long-acting beta-agonists [LABAs] such as salmeterol and formoterol) and combinations of LABAs and inhaled corticosteroids (ICS) (such as fluticasone-salmeterol [FSC] and budesonide-formoterol