1
|
Lahoz R, Proudfoot C, Fonseca AF, Loefroth E, Corda S, Jackson J, Cotton S, Studer R. Caregivers of Patients with Heart Failure: Burden and the Determinants of Health-Related Quality of Life. Patient Prefer Adherence 2021; 15:1153-1164. [PMID: 34079236 PMCID: PMC8165301 DOI: 10.2147/ppa.s297816] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To assess the burden among caregivers of patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤60%. The burden by New York Heart Association (NYHA) functional class was also characterized. PATIENTS AND METHODS A cross-sectional study was conducted in France, Germany, Italy, Spain, and UK from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive HF patients. Caregivers who accompanied the patient to their consultation completed a caregiver self-completion survey voluntarily, which included the Family Caregiver Quality of Life Questionnaire (FAMQOL) and 5-level 5-dimension EuroQol questionnaire (EQ-5D-5L). RESULTS We analyzed 361 caregivers of patients with HF (NYHA class I, n=41; II, n=212; III IV, n=108). Mean age of caregivers was 58.8 years (NYHA I/II/III-IV: 59.1/60.8/54.6 years; p=0.0029), with majority being females (73.1%). Caregivers spent on average 19.8 hours/week caring for a HF patient, which increased with increase in NYHA class (I/II/III-IV: 11.8/18.1/25.9 hours/week; p=0.0094). Caregivers (24.1%) reported providing emotional support/encouragement to patients as the most troublesome/inconvenient caregiving activity (no significant difference across NYHA class). Nearly one-third of caregivers experienced stress (NYHA I/II/III-IV: 17.1%/28.8%/40.7%; p=0.0111) and anxiety (26.8%/24.1%/39.8%; p=0.0127) due to caregiving burden. The overall FAMQOL mean score decreased significantly (poorer QoL) with increase in NYHA class (I/II/III-IV: 58.1/56.3/52.2; p=0.0069). A trend of decreasing scores with increasing NYHA class was observed across physical, emotional, and social domains (each p≤0.012). CONCLUSION Caregivers of HF patients with LVEF ≤60% experienced a significant burden, which was higher among caregivers of patients with more severe and symptomatic disease.
Collapse
Affiliation(s)
- Raquel Lahoz
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
- Correspondence: Raquel Lahoz Real World Evidence and Data Science, Cardio-Renal-Metabolic Franchise, Novartis Pharma AG, Asklepios 8-4, Basel, CH-4002, SwitzerlandTel +41 79 535 99 30 Email
| | - Clare Proudfoot
- Health Economics and Outcomes Research, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Ana Filipa Fonseca
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Emil Loefroth
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Stefano Corda
- Global Medical Affairs, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| | - James Jackson
- Real World Research, Adelphi Real World, Bollington, UK
| | - Sarah Cotton
- Real World Research, Adelphi Real World, Bollington, UK
| | - Rachel Studer
- Real World Evidence, Cardiovascular, Renal and Metabolism Franchise, Novartis Pharma AG, Basel, Switzerland
| |
Collapse
|
2
|
Fonseca AF, Lahoz R, Proudfoot C, Corda S, Loefroth E, Jackson J, Cotton S, Studer R. Burden and Quality of Life Among Female and Male Patients with Heart Failure in Europe: A Real-World Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1693-1706. [PMID: 34354345 PMCID: PMC8331086 DOI: 10.2147/ppa.s312200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To characterize symptoms, clinical burden, and health-related quality of life (HRQoL) among women and men with heart failure (HF) with a left ventricular ejection fraction (LVEF) of ≤60% in Europe. PATIENTS AND METHODS A real-world cross-sectional study was conducted in France, Germany, Italy, Spain, and United Kingdom from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive patients with HF. The same patients were invited to complete a questionnaire comprising patient-reported outcomes: the Minnesota Living with Heart Failure Questionnaire (MLHFQ), five-level five-dimension EuroQol questionnaire (EQ-5D-5L), Visual Analogue Scale (VAS), and Work Productivity and Activity Impairment questionnaire. RESULTS The mean age of 804 patients (men, n=517; women, n=287) was 68.6 years (men, 67.8 years; women, 70.2 years; p=0.0022). The mean LVEF was 44.7% (men, 43.6%; women, 46.8%; p<0.0001). Patients reported dyspnoea when active (overall, 55.7%; men, 56.0%; women, 55.3%), fatigue/weakness/faintness (34.5%; men, 32.9%; women, 37.2%), and oedema (20.3%; men, 18.7%; women, 23.1%) as the most troublesome HF symptoms. Overall, 54.1% of patients reported low mood/depression (men, 50.8%; women, 60.1%). The overall MLHFQ mean score was higher (ie, poorer HRQoL) among women vs men (37.9 vs 34.6; p=0.0481). MLHFQ was consistently higher (ie, poorer HRQoL) for women vs men across the physical (18.6 vs 16.6; p=0.0041) and emotional (9.4 vs 7.9; p=0.0021) scoring domains. Mean EQ-5D utility (0.69 vs 0.75; p=0.0046) and VAS scores (55.4 vs 61.3; p<0.0001) were lower among women compared with men. Overall, 23.4% of patients were hospitalized owing to HF in the previous year (men, 22.7%; women, 24.6%). Patients reported 43.2% activity impairment due to HF (men, 41.6%; women, 46.4%; p=0.01). CONCLUSION HF causes a substantial burden on patients, with a greater burden among women vs men. This gender-related difference is consistent with other HF studies, warranting further research to understand the underlying reasons.
Collapse
Affiliation(s)
- Ana Filipa Fonseca
- Novartis Pharma AG, Basel, Switzerland
- Correspondence: Ana Filipa Fonseca Real World Evidence Group, Cardio-Renal-Metabolic Franchise, Novartis Pharma AG, Novartis Campus, Basel, CH-4002, Switzerland Tel: +41 (0) 793489979 Email
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Loefroth E, Hughes M, Shi Y, Wang Y, Proudfoot C, Di Domenico M, Modgill V, Schlienger R, Studer R. Patient and clinical characteristics of heart failure patients concomitantly prescribed SGLT2 inhibitors and sacubitril/valsartan, a database cohort study using the Optum electronic health record data. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Sacubitril/valsartan (sac/val), an angiotensin receptor neprilysin inhibitor, reduces the risk for cardiovascular (CV) death or hospitalization for heart failure (HF) in HF with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are approved in patients with type 2 diabetes (T2D) and have shown to reduce the CV risk in T2D patients with established CV or at risk of CV disease. The SGLT2i dapagliflozin has shown to improve outcomes in patients with chronic HFrEF, with or without T2D, when used in addition to standard of care including sac/val. As the use of SGLT2i in HF evolves, and given the large overlap of HF and T2D populations, it is of interest to understand the population with concomitant use of sac/val and SGLT2i. This study describes the clinical characteristics of patients treated concomitantly with sac/val and SGLT2i or concomitantly with sac/val and dipeptidyl peptidase-4 inhibitors (DPP4i) or glucagon-like peptide-1 receptor agonists (GLP1), two comparable second line anti-diabetic drug classes.
Methods
This retrospective non-interventional study describes two mutually exclusive adult patient cohorts diagnosed with HF and T2D concomitantly prescribed sac/val and SGLT2i (cohort 1), or concomitantly prescribed sac/val and DDP4i/GLP1 (cohort 2). The index date was defined as the first date of concomitant use with prescriptions overlapping a minimum of 21 days. Patients were identified any time between 1/1/2015 and 30/6/2019 in the Optum® de-identified electronic health record (EHR) data from providers across the continuum of care.
Results
2.3 million HF patients were identified, and 41.6% had a T2D diagnosis. 560 patients were concomitantly prescribed sac/val and SGLT2i (cohort 1) and 1,566 concomitantly sac/val and DDP4/GLP1 (cohort 2). There was a higher proportion of females in cohort 2 (35.0% vs 27.9%). Mean age was higher in cohort 2 (66.4 vs 61.4 years). The mean estimated glomerular filtration rate was 85.93 (SD 23.43) ml/min/1.73m2 (cohort 1) and 72.10 (Std. 27.11) ml/min/1.73m2 (cohort 2). The proportion of stage 3 CKD (<60 to >30 ml/min/1.73m2) was 11.8% (cohort 1) and 24.4% (cohort 2). Mean systolic blood pressure was similar, 120 mmHg (cohort 1) and 122 mmHg (cohort 2). Mean hemoglobin was 13.60 g/dl (cohort 1) and 12.43 g/dl (cohort 2). Median (IQR) NT-proBNP differed between the two cohorts, 914 (2154) pg/ml (cohort 1) and 2,290 (5,301) pg/ml (cohort 2) but with complete values available in only 17.7 and 19.0% of each cohort.
Conclusions
This descriptive analysis of concomitant prescription of sac/val and SGLT2i or DPP4/GLP1 highlights differences in the clinical characteristics between the two cohorts. The patients treated with sac/val and SGLT2i start with a more favorable clinical profile compared to the patients treated with sac/val and DPP4/GLP1. Further analyses are needed to determine if these differences are driven by age, gender or other factors.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
Collapse
Affiliation(s)
| | - M Hughes
- Novartis Ireland Limited, Dublin, Ireland
| | - Y Shi
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | - Y Wang
- Novartis Pharmaceuticals Corporation, East Hanover, United States of America
| | | | | | - V Modgill
- Novartis Pharma AG, Basel, Switzerland
| | | | - R Studer
- Novartis Pharma AG, Basel, Switzerland
| |
Collapse
|
4
|
Kostikas K, Price D, Gutzwiller FS, Jones B, Loefroth E, Clemens A, Fogel R, Jones R, Cao H. Clinical Impact and Healthcare Resource Utilization Associated with Early versus Late COPD Diagnosis in Patients from UK CPRD Database. Int J Chron Obstruct Pulmon Dis 2020; 15:1729-1738. [PMID: 32764917 PMCID: PMC7371991 DOI: 10.2147/copd.s255414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/27/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Previous studies have shown that opportunities to diagnose chronic obstructive pulmonary disease (COPD) early are often missed in primary care. This retrospective study aimed to utilize secondary data from the United Kingdom (UK) healthcare system to understand the impact of early versus late diagnosis of COPD. Patients and Methods Newly diagnosed COPD patients were identified in the UK Clinical Practice Research Database from 2011 to 2014. Patients whose 5-year medical data before diagnosis revealed ≥3 counts of eight indicators of early COPD were deemed as late-diagnosed, whereas others were deemed as early-diagnosed. We assessed patients’ characteristics; time-to-first, risk, and rates of exacerbation; and healthcare resource utilization (COPD-related clinic visits, Accident and Emergency visits, and hospitalizations) in late- versus early-diagnosed patients. Results Of 10,158 patients included in the study, 6783 (67%) were identified as late-diagnosed and 3375 (33%) as early-diagnosed. The median time-to-first exacerbation was shorter in late-diagnosed (14.5 months) versus early-diagnosed (29.0 months) patients, with a significant risk of exacerbation (hazard ratio 1.46 [95% confidence interval: 1.38–1.55]). Additionally, the exacerbation rate (per 100 person-years) over 3 years was higher in late (108.9) versus early (57.2) diagnosed patients. Late-diagnosed patients had a significantly higher rate of COPD hospitalizations (per 1000 patient years) compared with early-diagnosed patients during 2 and 3 years of follow-ups (P = 0.0165 and P < 0.0001, respectively). Conclusion Results showed that a significant percentage of COPD patients in UK primary care are diagnosed late. A late COPD diagnosis is associated with a shorter time-to-first exacerbation and a higher rate and risk of exacerbations compared with early diagnosis. Additionally, late diagnosis of COPD is associated with a higher rate of COPD-related hospitalizations compared with early diagnosis.
Collapse
Affiliation(s)
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | | | | | | | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland.,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Rupert Jones
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| |
Collapse
|
5
|
Geale K, Darabi H, Lindh M, Fues Wahl H, Ström O, Cao H, Alvares L, Dodge R, Loefroth E, Altraja A, Backer V, Backman H, Bjermer L, Bossios A, Bøgvald Aarli B, Dahlén B, Hilberg O, Janson C, Kankaanranta H, Karjalainen J, Kauppi P, Kilpeläinen M, Lehmann S, Lehtimäki L, Lundbäck B, Sandström T, Ulrik CS, Sverrild A, Viinanen A, von Bülow A, Yasinska V, Porsbjerg C. NORDSTAR: paving the way for a new era in asthma research. Eur Respir J 2020; 55:13993003.02476-2019. [PMID: 32165398 DOI: 10.1183/13993003.02476-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/07/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Kirk Geale
- Quantify Research, Stockholm, Sweden kirk.geale@umu.,Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | - Oskar Ström
- Quantify Research, Stockholm, Sweden.,Dept of Learning, Informatics, Management and Ethics (LIME), Medical Management, Stockholm, Sweden
| | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Rikke Dodge
- Novartis Pharmaceuticals A/S, Copenhagen, Denmark
| | | | - Alan Altraja
- Dept of Pulmonary Medicine, University of Tartu, and Dept of Pulmonary Medicine, Tartu University Hospital Tartu, Estonia
| | - Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Helena Backman
- Dept of Public Health and Clinical Medicine, University Hospital of Umeå, Umeå University, Umeå, Sweden
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Dept of Clinical Sciences, Lund, Sweden
| | - Apostolos Bossios
- Dept of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Bernt Bøgvald Aarli
- Dept of Clinical Science, University of Bergen, Haukeland University hospital, Bergen, Norway
| | - Barbro Dahlén
- Dept of Medicine, Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden
| | - Ole Hilberg
- IRS-center, Lillebælt Hospital, Medicine, Vejle, Denmark
| | - Christer Janson
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | | | - Paula Kauppi
- Dept of Allergy, Respiratory Diseases and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maritta Kilpeläinen
- Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Dept of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tempere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bo Lundbäck
- Dept of Internal Medicine at Institute of Medicine/Krefting Research Centre, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Sandström
- Dept of Public Health and Clinical Medicine, University Hospital of Umeå, Umeå University, Umeå, Sweden
| | - Charlotte Suppli Ulrik
- Dept of Respiratory Medicine, Hvidovre University Hospital and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Asger Sverrild
- Dept of Respiratory Medicine, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Arja Viinanen
- Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Dept of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Anna von Bülow
- Dept of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Valentyna Yasinska
- Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Celeste Porsbjerg
- Dept of Respiratory Medicine, Respiratory Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
6
|
Buhl R, Heaney LG, Loefroth E, Larbig M, Kostikas K, Conti V, Cao H. One-year follow up of asthmatic patients newly initiated on treatment with medium- or high-dose inhaled corticosteroid-long-acting β 2-agonist in UK primary care settings. Respir Med 2019; 162:105859. [PMID: 31916534 DOI: 10.1016/j.rmed.2019.105859] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/07/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Global Initiative for Asthma (GINA) recommends medium- or high-dose inhaled corticosteroid-long-acting β2-agonist (ICS-LABA) as preferred treatments for patients with moderate-to-severe asthma. Limited data is available on how step 4/5 patients respond to ICS-LABA and how they step up/down in clinical practice. METHODS This retrospective cohort study assessed the characteristics, control status, treatment pathways, and healthcare resource utilization in patients with asthma during one year after initiating medium- or high-dose ICS-LABA. Data from the United Kingdom Clinical Practice Research Datalink were analysed between January 01, 2006 and February 28, 2016. RESULTS Overall, 29,229 and 16,575 patients initiated medium- and high-dose ICS-LABA, and 35.1% and 45.7% of patients, respectively, remained uncontrolled. The proportions of patients who were adherent to treatment (Medication Possession Ratio ≥80%) were 37.8% and 49.1% in the medium- and high-dose ICS-LABA cohorts, respectively. Among these adherent patients, 63.8% in the medium- and 70% in the high-dose cohorts remained uncontrolled. In patients who stepped up therapy in the medium-dose cohort (19.0%), the common step-up choices were add-on leukotriene receptor antagonist (LTRA) (42.2%), long-acting muscarinic antagonist (LAMA) (23.3%), and increase in ICS dose (22.9%). In patients who stepped up therapy in the high-dose cohort (26.1%), the common step-up choices were add-on LAMA (43.8%) and LTRA (42.1%). Healthcare resource utilization was higher in uncontrolled patients, regardless of the ICS-LABA dose. CONCLUSIONS Many patients remain uncontrolled on both medium- or high-dose ICS-LABA, highlighting the need for timely assessment of asthma control to increase treatment intensity, following evidence-based treatment pathways.
Collapse
Affiliation(s)
- Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany.
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | | | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece
| | | | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| |
Collapse
|
7
|
Stolz D, Kostikas K, Loefroth E, Fogel R, Gutzwiller FS, Conti V, Cao H, Clemens A. Differences in COPD Exacerbation Risk Between Women and Men: Analysis From the UK Clinical Practice Research Datalink Data. Chest 2019; 156:674-684. [PMID: 31103696 DOI: 10.1016/j.chest.2019.04.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Historically, COPD has been considered to affect mostly older men with a history of smoking; however, in recent times, its prevalence and mortality rates have steadily increased among women. OBJECTIVES The goal of this study was to systematically assess differences in COPD expression between women and men in UK primary care clinics who were newly diagnosed with COPD. METHODS This retrospective cohort study compared women and men with an incident diagnosis of COPD by using electronic medical records data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics data. The overall study period was between January 1, 2006, and February 28, 2016; patients with an incident diagnosis of COPD between January 1, 2010, and February 28, 2015, were analyzed. RESULTS A cohort of 22,429 patients were identified as incident patients and included in the study; 48% of patients with COPD were women. The risk of first moderate or severe exacerbation was 17% greater in women than in men (hazard ratio, 1.17; 95% CI, 1.12-1.23), with a median time to first exacerbation of 504 days for women and 637 days for men. These differences were more prominent in the younger age group (≥ 40 years to < 65 years), as well as in Global Initiative for Chronic Obstructive Lung Disease 2016 groups B, C, and D and in individuals with moderate to severe airflow obstruction. The annual rate of moderate or severe exacerbations was higher in women compared with men in the first, second, and third year of follow-up. CONCLUSIONS These results highlight the unmet need for appropriate identification and management of women with COPD in clinical practice.
Collapse
Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Konstantinos Kostikas
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland; Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece.
| | | | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland; Heart Center Freiburg University, Cardiology and Angiology I, Faculty of Medicine, Freiburg, Germany
| |
Collapse
|
8
|
Inoue H, Kozawa M, Milligan KL, Funakubo M, Igarashi A, Loefroth E. A retrospective cohort study evaluating healthcare resource utilization in patients with asthma in Japan. NPJ Prim Care Respir Med 2019; 29:13. [PMID: 31036818 PMCID: PMC6488614 DOI: 10.1038/s41533-019-0128-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/29/2019] [Indexed: 01/06/2023] Open
Abstract
Although the global economic burden of asthma is well described, detailed data regarding Asia, particularly for Japan, are relatively scarce. This retrospective study aims to fill this evidence gap by evaluating asthma-associated healthcare resource utilization (HCRU) and economic burden in Japanese patients aged ≥16 years, identified using anonymized patient data from the Japan Medical Data Center (JMDC) database from April 2009 to March 2015. Asthma severity was classified according to asthma treatment guidelines from the Japanese Society of Allergology. HCRU was calculated based on hospitalizations, emergency room visits, outpatient visits, and prescriptions. Incidence rate ratios (IRRs) for HCRU and per-patient-per-year direct costs were reported. In addition, differences across HCRU and cost variables for severe versus non-severe asthma patients were also compared. Of 541,434 asthma cases identified from the JMDC database during the study period, 54,433 patients who met the inclusion criteria were included in this analysis. HCRU and costs were heavily concentrated within severe asthma, a subgroup comprising 12.7% of total study population. Moreover, patients with severe asthma had significantly higher all-cause hospitalizations, outpatient visits, outpatient prescriptions (IRR [95% CI], 1.60 [1.46–1.76]; 1.43 [1.41–1.45]; 1.24 [1.22–1.25], respectively), and total medical costs (mean ± SD costs, US$ 4345 ± 11,104 versus US$ 1528 ± 3989, P < 0.001 (t-test); US$ 1 = 110 JPY) compared with those with non-severe asthma. The burden of asthma is significantly and disproportionately concentrated in Japanese severe asthma patients, suggesting clinical failure to achieve adequate disease control. This study highlights the unmet needs for severe asthma in Japan and provides a catalyst for important dialogues in advancing public health.
Collapse
Affiliation(s)
- Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | | | | | | | - Ataru Igarashi
- Department of Drug Policy and Management, The University of Tokyo, Tokyo, Japan
| | | |
Collapse
|
9
|
Geale K, Darabi H, Eklund O, Lindh M, Fues Wahl H, Ström O, Cao H, Alvares L, Dodge R, Loefroth E, Altraja A, Backer V, Backman H, Bjermer L, Bossios A, Dahlén B, Janson C, Kankaanranta H, Kauppi P, Kilpelainen M, Lehtimäki L, Sandström T, Suppli Ulrik C, Viinanen A, Porsbjerg C. Late Breaking Abstract - NORdic Database for aSThmA Research (NORDSTAR): Swedish and Finnish patients. Epidemiology 2018. [DOI: 10.1183/13993003.congress-2018.pa1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Hamed K, Conti V, Tian H, Loefroth E. Adherence to tobramycin inhaled powder vs inhaled solution in patients with cystic fibrosis: analysis of US insurance claims data. Patient Prefer Adherence 2017; 11:831-838. [PMID: 28490864 PMCID: PMC5414718 DOI: 10.2147/ppa.s134759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Tobramycin inhalation powder (TIP), the first dry-powder inhaled antibiotic for pulmonary Pseudomonas aeruginosa infection, is associated with reduced treatment burden, increased patient satisfaction, and higher self-reported adherence for cystic fibrosis (CF) patients. We compared adherence in CF patients newly treated with TIP with those newly treated with the traditional tobramycin inhalation solution (TIS), using US insurance claims data. PATIENTS AND METHODS From the Truven MarketScan® database, we identified CF patients chronically infected with P. aeruginosa who had been prescribed TIP between May 1, 2013 to December 31, 2014, or TIS between September 1, 2010 to April 30, 2012 with at least 12 months of continuous medical and pharmacy benefits prior to and following prescription. TIP and TIS adherence levels were assessed. RESULTS A total of 145 eligible patients were identified for the TIP cohort and 306 for the TIS cohort. Significant differences in age distribution (25.0 vs 21.9 years for TIP vs TIS, respectively, P=0.017), type of health plan (P=0.014), employment status (72.4% vs 63.4% of TIP vs TIS patients in full-time employment, P=0.008), and some comorbidities were observed between the two cohorts. Although a univariate analysis found no significant differences between TIP and TIS (odds ratio [OR] 1.411, 95% confidence interval [CI] 0.949-2.098), TIP was moderately associated with higher adherence levels compared with TIS in a multivariable analysis, once various demographic and clinical characteristics were adjusted for. These included geographic location (OR: 1.566, CI: 1.016-2.413) and certain comorbidities. CONCLUSION This study of US patient data supports previous findings that TIP is associated with better adherence compared with TIS; however, further studies will be required to fully elucidate differences in adherence between TIP and TIS.
Collapse
Affiliation(s)
- Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
- Correspondence: Kamal Hamed, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, USA, Tel +1 862 778 4780, Email
| | | | - Hengfeng Tian
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | |
Collapse
|