Management of pharmacological treatment in patients with COPD and the direct cost of long-term anticholinergic therapy: real-word experience

Abstract

Objective: To describe the experience with the use of long-term anticholinergic therapy available in the public service. Method: A cross-sectional study with data collected in the real world. The sample consisted of SUS users who received inhaled LAMAs for the treatment of COPD between November 2019 and November 2020. Inclusion criteria were: diagnosis of COPD, being in clinical follow-up by the COPD health team, having record of anticholinergics dispensing by the pharmacy during the study period, having been using LAMA (tiotropium, glycopyrronium and umeclidenium) for at least 3 months. Patients with absence or insufficiency of data and without medical appointments for more than a year and a half from the final period of the study were excluded. Sociodemographic analysis, clinical assessment of patients and quality of life questionnaires were performed. Continuous variables were expressed as mean and standard deviation and analyzed by t Student, and categorical variables were expressed as absolute (n) and relative (%) frequency and analyzed by chi-square or Fisher, with confidence level <0.05. For direct costs, the analysis were performed in a simplified way, using the service’s anticholinergics dispensing and stock data. Results: The study included 197 patients, 177 using anticholinergic tiotropium and 20 using glycopyrronium or umeclidenum. There was no significant difference when analyzing the groups regarding age (p=0.814), sex (p=0.780) and comorbidities (p >0.05). It was found that patients had polypharmacy (83.8%) and 74.1% of patients used 3 or more types of devices. We found in the population a predominance of patients classified as GOLD 3 and profile B, being represented by 45.2% (n = 89) and 66.5% (n = 131), respectively, showing a more severe population. In relation to the specific questionnaires, in both groups, we noticed an increase in the CAT value and a tendency towards a worsening in the mMRC. For the direct costs with the treatment, an annual expense of U$ 124.474,35 was estimated. Based on a drug dispensing strategy, we were able to predict savings of U$ 13.915,77/year for this treatment. Conclusions: Patients with severe COPD tend to use more inhalation devices. The availability of pharmacotherapeutic alternatives by the public service can contribute to the individualization of anticholinergic treatments and enable a more adequate assessment of therapy according to the patient’s clinical profile, linked to possible economic strategies related to individualized treatment.