Ajmera M, Kurosky S, Sambamoorthi U. Association between comorbidities and maintenance medication persistence among Medicaid beneficiaries with newly-diagnosed COPD. Poster presented at the ISPOR 19th Annual European Congress; November 1, 2016. Vienna, Austria. [abstract] Value Health. 2016 Nov; 19(7):A559.


OBJECTIVES: Comorbidities are highly prevalent among individuals with chronic obstructive pulmonary disease (COPD). The association between comorbidities and persistence on COPD maintenance medications (i.e., long-acting bronchodilator agents [LABA]) is not well studied. This study sought to examine the association between comorbidities and LABA persistence among Medicaid beneficiaries with newly diagnosed COPD.

METHODS: A retrospective cohort study using data from multiple years (2005-2008) of Medicaid Analytic eXtract (MAX) was conducted. Medicaid beneficiaries with newly diagnosed COPD initiating LABA (N = 6,119) were identified. Commonly occurring comorbidities including arthritis, anxiety, cardiovascular diseases (CVD), depression, diabetes, hypertension, hyperlipidemia, and osteoporosis were identified and grouped to create an operational variable with the following comorbidity groups: 1) physical condition only, 2) mental condition only, 3) both physical and mental conditions, and 4) no comorbidity. LABA persistence was measured in the 180-day period following the initiation of treatment (index date). Medication persistence was defined as continuous use (i.e., without a 60-day gap in prescription refills of LABA). Time to discontinuation from initiation of LABA treatment was estimated. Kaplan-Meier estimates with log-rank tests were obtained to estimate and compare the median time to discontinuation across comorbidity groups. A multivariable cox-proportional hazard model was fit to assess the association between comorbidity categories and LABA persistence.

RESULTS: During the follow-up period, 61% patients discontinued maintenance medications (LABA). Patients with mental conditions only had significantly shorter time to discontinuation compared to those without comorbidities (96 days vs. 114 days; p< 0.05). After controlling for patient characteristics individuals with physical conditions only (HR: 1.10; 95% CI: 1.01-1.20), mental conditions only (HR: 1.18; 95% CI: 1.03-1.36) and both conditions (HR: 1.14; 95% CI: 1.02-1.36) had increased hazards of discontinuation as compared to those without any comorbidities.

CONCLUSIONS: These findings suggest poor COPD maintenance medication management among patients with COPD and comorbidities.

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