Chronic Obstructive Pulmonary Disease (Copd) Drug Utilization: An Analysis With The Ramq Database


      The objectives of this study were to describe the COPD population and treatment patterns, to estimate treatment adherence, and to compare medication cost, in a real life setting, using the Régie de l’assurance maladie du Québec (RAMQ) database.


      Patients who had a diagnosis of COPD (ICD-9 codes: 4910-4929, 4960-4969), or who received at least one script of a COPD medication from January 1st 2010 to January 31st 2013 were selected. Patient’s characteristics, drug utilization patterns, adherence, and costs were analyzed.


      Among patients with a COPD diagnosis, 3,015 patients were treated with LABA (long-acting beta-agonists); 12,099 with LAAC (long-acting anticholinergics); and 11,029 with a fixed-combination of LABA/inhaled corticosteroids (ICS). A proportion of 26.1%, 23.6%, and 31.0% of LABA, LAAC, and LABA/ICS users, respectively, had a mixed diagnosis with asthma. More than 80% of patients on long-acting agent treatments used more than one medication in concomitance. The results showed a high usage of ICS in concomitance with LAAC (20.3% in free-combination; 53.2% in fixed-combination). In incident users (no COPD medication in the previous year) treated with triple therapy LAAC+LABA/ICS (n=125), average time to triple therapy was less than six months. The compliance, estimated over up to 1-year period, of long-acting COPD medications given more than once daily was 41.4%. The switch to once-daily medication was associated with a compliance of 61.4%. The compliance of the medications used before the switch to once-daily medication was 30.5%. The persistence of long-acting COPD medications given more than once daily was 72.3% at 6 months. At 6 months, the persistence of once-daily medication was 76.7%. The mean monthly cost per medication was CDN$46.65 (SD=39.21) for LABA users, CDN$63.14 (SD=121.79) for LAAC users, and CDN$96.20 (SD=162.43) for LABA/ICS users.


      Medication given once daily was associated with a higher level of treatment compliance.