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dc.contributor.authorShah, Chintal
dc.date.accessioned2024-03-22T13:50:57Z
dc.date.available2024-03-22T13:50:57Z
dc.date.issued2023
dc.identifier.urihttp://hdl.handle.net/10713/21573
dc.descriptionUniversity of Maryland, Baltimore. School of Pharmacy. Ph.D. 2023.en_US
dc.description.abstractIntroduction: Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent condition in the United States (US). Among individuals with moderate to very severe COPD, inhalation therapy is the mainstay of disease management, with the goal to reduce COPD exacerbations. Maintenance medications, especially combinations of long-acting beta2 agonist (LABA)/long-acting muscarinic antagonist (LAMA) or LABA/inhaled corticosteroids (ICS), are commonly used. This dissertation aimed to examine the (i) economic burden of COPD, (ii) comparative effectiveness of LABA/LAMA and LABA/ICS fixed dose combination (FDC) single inhaler therapy across various subgroups, and (iii) comparative effectiveness of LABA/LAMA combinations with different ingredients and inhaler types, vilanterol/umeclidinium (VI/UMEC) and olodaterol/tiotropium (OLO/TIO). Methods: Medical Expenditure Panel Survey data was used to estimate the economic burden of COPD (Aim 1). COPD-specific (adjusted) costs were determined for various service categories using a regression-based weighted two-part model among patients aged 45 years and older. Medicare Chronic Conditions Warehouse data was used for the comparative effectiveness studies (Aim 2, Aim 3). A new user active comparator retrospective cohort study design was utilized, and the outcome of interest was time to first COPD exacerbation. To ensure comparability between groups, they were matched based on their high-dimensional propensity scores. Results: The total COPD-specific direct medical cost was 2018 US $4,322 (Standard Error (SE): US $577) per patient per year with prescription drugs contributing US $1,887 (SE: US $216). The resultant overall annual total COPD-specific cost was US $24.0 billion, with prescription drugs contributing US $10.5 billion. For the interclass comparative effectiveness analysis, the hazard ratio (HR) of time to COPD exacerbation was 0.846 (95% Confidence interval (CI): 0.776-0.923) for LABA/ICS compared to LABA/LAMA initiators. Among LABA/LAMA FDCs, the HR of time to first COPD exacerbation was 0.948 (95% CI: 0.813-1.105) for individuals initiating OLO/TIO versus VI/UMEC. Conclusion: This dissertation found that COPD poses a significant economic burden on the US healthcare system, with prescription drugs being a major contributor. Optimizing therapy can help reduce this burden. While a statistically significant interclass difference was observed between LABA/LAMA and LABA/ICS initiators, no statistically significant intraclass difference was observed between initiators of LABA/LAMA FDCs: VI/UMEC and OLO/TIO.en_US
dc.language.isoen_USen_US
dc.subject.meshBronchodilator Agentsen_US
dc.subject.meshPulmonary Disease, Chronic Obstructiveen_US
dc.subject.meshHealth Care Costsen_US
dc.titleThe Economic Burden of Chronic Obstructive Pulmonary Disease and Comparative Effectiveness of Maintenance Inhaler Medications in the United Statesen_US
dc.typedissertationen_US
dc.date.updated2024-02-01T02:05:14Z
dc.language.rfc3066en
dc.contributor.advisorZafari, Zafar


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