Inhaler Formulary Change in COPD and the Association with Exacerbations, Health Care Utilization, and Costs.

Autor:	Duan KI; Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada.; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States., Donovan LM; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States.; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States., Spece LJ; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States.; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States., Wong ES; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States.; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States.; Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States., Feemster LC; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States.; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States., Bryant AD; Kaiser Permanente Washington, Seattle, Washington, United States., Plumley R; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States., Crothers K; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States.; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States., Au DH; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States.; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States.
Jazyk:	angličtina
Zdroj:	Chronic obstructive pulmonary diseases (Miami, Fla.) [Chronic Obstr Pulm Dis] 2024 Jan 25; Vol. 11 (1), pp. 37-46.
DOI:	10.15326/jcopdf.2023.0425
Abstrakt:	Rationale: Prescription formularies specify which medications are available to patients. Formularies change frequently, potentially forcing patients to switch medications for nonclinical indications (nonmedical switching). Nonmedical switching is known to impact disease control and adherence. The consequences of nonmedical switching have not been rigorously studied in COPD. Methods: We conducted a cohort study of Veterans with COPD on inhaler therapy in January 2016 when formoterol was removed from the Department of Veterans Affairs (VA) national formulary. A 2-point difference-in-differences analysis using multivariable negative binomial and generalized linear models was performed to estimate the association of the formulary change with patient outcomes in the 6 months before and after the change. Our primary outcome was the number of COPD exacerbations in 6 months, with secondary outcomes of total health care encounters and encounter-related costs in 6 months. Results: We identified 10,606 Veterans who met our inclusion criteria, of which 409 (3.9%) experienced nonmedical switching off formoterol. We did not identify a change in COPD exacerbations (-0.04 exacerbations; 95% confidence interval [CI] -0.12, 0.03) associated with the formulary change. In secondary outcome analysis, we did not observe a change in the number of health care encounters (-0.12 visits; 95% CI -1.00, 0.77) or encounter-related costs ($369; 95% CI -$1141, $1878). Conclusions: Among COPD patients on single inhaler therapy, nonmedical inhaler switches due to formulary discontinuation of formoterol were not associated with changes in COPD exacerbations, encounters, or encounter-related costs. Additional research is needed to confirm our findings in more severe disease and other settings. (JCOPDF © 2024.)
Databáze:	MEDLINE
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