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Can Adherence to and Persistence with Inhaled Long-acting Bronchodilators Improve the Quality of Life in Patients with Chronic Obstructive Pulmonary Disease? Results from a German Disease Management Program

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Abstract

Background and Objective

Adherence to and persistence with inhaled long-acting bronchodilators (ILAB), is commonly considered to be a relevant driver of perceived health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD), but the topic is rarely studied with real-world data. Using survey and health insurance claims data, this study investigates the effect of adherence to and persistence with ILAB on EQ-5D-5L visual analog scale (VAS) in ILAB users who were enrolled in the German disease management programs (DMP) for COPD.

Methods

Included ILAB users were aged ≥ 18 years, continuously insured with AOK Bavaria and enrolled in the DMP for COPD. Adherence to ILAB [proportion of days covered (PDC); PDC ≥ 80%], and persistence (days of uninterrupted ILAB therapy) were assessed in the year preceding the study’s HRQoL questionnaire. In a cross-sectional design we applied quasi-Poisson models with log link function and subgroup analyses. The robustness of results was analyzed with comprehensive sensitivity analyses.

Results

Patients with PDC ≥ 80% had 2.96% higher VAS scores than patients with lower PDCs. From all analyses, patients with GOLD stage III had the highest effects from PDC ≥ 80% (5.33% increased VAS). Patients without heart failure profited significantly more from PDC ≥ 80% (+ 4.34% vs − 2.88%) and from an additional persistent day (+ 0.01% vs – 0.01%) than patients with heart failure.

Conclusions

Overall, ILAB users significantly profited from PDC ≥ 80%, but not from continuous PDC or persistent days. In secondary subgroup analyses, patients with GOLD stage III and patients without heart failure particularly profited from PDC ≥ 80%. Only patients without heart failure particularly profited from more persistent days. Because identified effects were small and often not robust, advancing adherence and persistence alone may not improve the German DMP for COPD substantially.

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Author information

Authors and Affiliations

  1. Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-Universität München, Ludwigstraße 28 RG, 80539, Munich, Germany

    Gundula Krack & Reiner Leidl

  2. Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany

    Gundula Krack, Florian Kirsch, Larissa Schwarzkopf & Reiner Leidl

  3. Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Max-Lebsche-Platz 31, 81377, Munich, Germany

    Larissa Schwarzkopf & Reiner Leidl

  4. IFT-Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany

    Larissa Schwarzkopf

  5. AOK Bayern, Service Center of Health Care Management, Regensburg, Germany

    Anja Schramm

Authors
  1. Gundula Krack
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  2. Florian Kirsch
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  5. Reiner Leidl
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Corresponding author

Correspondence to Gundula Krack.

Ethics declarations

Funding

The project is funded by the Federal Joint Committee (G-BA), Innovation Fund (funding code 01VSF16025).

Competing interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Ethics approval

The ethics committee of the Ludwig Maximilians University, Munich, approved the study (vote no. 17-358).

Consent to participate

Participants provided written informed consent at the time of inclusion in the disease management program.

Consent to publish

Not applicable.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available and according to the data protection concept approved by the responsible data security officials and the ethics committee.

Code availability

Not applicable.

Author contributions

GK developed the statistical models, analyzed the data, wrote the manuscript, and acted as the corresponding author. FK was responsible for the entire data management of the LQ-DMP study. LS is the study statistician and provided continuous support with regard to methodological questions. RL is principal investigator of the LQ-DMP project and provided advice on content related questions. Supported by AS, LS and RL conceived the study and decided on the research questions to be answered. All coauthors critically commented on earlier manuscript drafts and approved the final version.

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Krack, G., Kirsch, F., Schwarzkopf, L. et al. Can Adherence to and Persistence with Inhaled Long-acting Bronchodilators Improve the Quality of Life in Patients with Chronic Obstructive Pulmonary Disease? Results from a German Disease Management Program. Clin Drug Investig 41, 989–998 (2021). https://doi.org/10.1007/s40261-021-01083-w

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