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Purpose: Triple therapy (long-acting muscarinic antagonist/long-acting β 2 -agonist/inhaled corticosteroid) is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence. This study assessed comparative adherence and persistence to single-inhaler triple therapy (SITT) versus MITT among patients with COPD in a real-world setting in Germany., Patients and Methods: This retrospective analysis using the WIG2 benchmark database identified patients with COPD newly initiating triple therapy with MITT or SITT (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or formoterol/beclomethasone/glycopyrronium bromide [FOR/BDP/GLY]) November 2017-June 2019. Eligible patients were ≥35 years with 1 year's continual insurance prior to triple therapy initiation and no previous record of triple therapy. Inverse probability of treatment weighting was used to balance baseline characteristics. Adherence was measured using proportion of days covered (PDC) at 6, 12, and 18 months post-treatment initiation; persistence (time until treatment discontinuation) was measured at 6, 12, and 18 months, with a gap of >30 days used to define non-persistence., Results: Of 5710 patients included in the analysis (mean age 66 years), 71.4% initiated MITT and 28.6% initiated SITT (FF/UMEC/VI: 41.4%; FOR/BDP/GLY: 58.6%). Mean PDC was higher among SITT versus MITT users at all time points; at each time point, mean PDC was highest among FF/UMEC/VI users. During the first 6 months following treatment initiation, higher adherence was exhibited by FF/UMEC/VI (29%) and FOR/BDP/GLY (19%) users versus MITT users. Over the entire observation period, FF/UMEC/VI users had the highest proportion of persistent patients; at 18 months, 16.5% of FF/UMEC/VI users were persistent versus 2.3% of MITT users., Conclusion: Patients initiating SITT in Germany had significantly higher adherence and persistence compared with patients initiating MITT over 6 to 18 months following treatment initiation. Among SITT, FF/UMEC/VI users had the highest proportion of adherence and persistence., Competing Interests: CFV has given presentations at symposia and/or served on scientific advisory boards sponsored by Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, Grifols, GSK, Insmed, MedUpdate, Menarini, Novartis, Nuvaira, Roche, and Sanofi. KMB is a full-time employee of insaf Respiratory Research Institute. He has received personal or institutional compensation for services on advisory boards or consulting for AstraZeneca, Bosch Healthcare, Berlin Chemie, Boehringer Ingelheim, Chiesi, Clario, Elpen, GSK, Mundipharma, Novartis, Pohl Boskamp, Sanofi, sterna, and Zentiva; and compensation for speaker activities in scientific meetings supported by AstraZeneca, Berlin Chemie, Boehringer Ingelheim, ERT, GSK, Novartis, Pfizer, Pohl Boskamp, Sanofi, and Teva, all outside the submitted work. The institution has received compensations for design and performance of clinical trials from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, Parexel, Pearl Therapeutics, sterna, and Zentiva. MS is an employee of ZEG Berlin, which received funding from GSK to conduct this study. NK and LMR are employees of WIG2 GmbH, that conducted the study on behalf of GSK. JC, CC, SGN, ASI, and GR are employees of, and/or hold financial equities in GSK. ASI is also a part-time, unpaid professor at McMaster University. The authors report no other conflicts of interest in this work., (© 2024 Vogelmeier et al.)

Purpose: To assess patient characteristics of users and new initiators of triple therapy for chronic obstructive pulmonary disease (COPD) in Germany., Patients and Methods: Retrospective cohort study of patients with COPD and ≥1 prescription for single-inhaler triple therapy (SITT; fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or beclomethasone dipropionate/glycopyrronium bromide/formoterol [BDP/GLY/FOR]) or multiple-inhaler triple therapy (MITT), using data from the AOK PLUS German sickness fund (1 January 2015-31 December 2019). The index date was the first date of prescription for FF/UMEC/VI or BDP/GLY/FOR (SITT users), or the first date of overlap of inhaled corticosteroid, long-acting β 2 -agonist, and long-acting muscarinic antagonist (MITT users). Two cohorts were defined: the prevalent cohort included all identified triple therapy users; the incident cohort included patients newly initiating triple therapy for the first time (no prior use of MITT or SITT in the last 2 years). Patient characteristics and treatment patterns were assessed on the index date and during the 24-month pre-index period., Results: In total, 18,630 patients were identified as prevalent triple therapy users (MITT: 17,945; FF/UMEC/VI: 700; BDP/GLY/FOR: 908; non-mutually exclusive) and 2932 patients were identified as incident triple therapy initiators (MITT: 2246; FF/UMEC/VI: 311; BDP/GLY/FOR: 395; non-mutually exclusive). For both the prevalent and incident cohorts, more than two-thirds of patients experienced ≥1 moderate/severe exacerbation in the preceding 24 months; in both cohorts more BDP/GLY/FOR users experienced ≥1 moderate/severe exacerbation, compared with FF/UMEC/VI and MITT users. Overall, 97.9% of prevalent triple therapy users and 86.4% of incident triple therapy initiators received maintenance treatment in the 24-month pre-index period., Conclusion: In a real-world setting in Germany, triple therapy was most frequently used after maintenance therapy in patients with recent exacerbations, in line with current treatment recommendations., Competing Interests: Kai-Michael Beeh is a full-time employee of Insaf Respiratory Research Institute. He has received personal or institutional compensation for services on advisory boards or consulting for AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Chiesi, Elpen, GSK, Mundipharma, Novartis, Pohl Boskamp, Sanofi, sterna, and Zentiva, and compensation for speaker activities in scientific meetings supported by AstraZeneca, Berlin Chemie, Boehringer Ingelheim, ERT, GSK, Novartis, Pfizer, Pohl Boskamp, Sanofi, and Teva, all outside the submitted work. The institution has received compensation for design and performance of clinical trials from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, Parexel, Pearl Therapeutics, sterna, and Zentiva. Kieran J Rothnie, Jing Claussen, Chris Compton, and Afisi S Ismaila are employees of and/or hold stocks/shares in GSK. Afisi S Ismaila is also an unpaid part-time member of the McMaster University faculty. Alexandrosz Czira was an employee of GSK at the time of the study and now works for Gedeon Richter PLC. Fränce Hardtstock and Rachel K Knapp participated in this study as employees of Cytel/Ingress-Health. Cytel/Ingress-Health received funding from GSK to conduct the study. Thomas Wilke reports grants from GSK and Cytel/Ingress-Health during the conduct of the study and grants from Apontis, Janssen, and Pfizer outside the submitted work. Thomas Wilke received honoraria and other financial support from Cytel Inc., which does studies with all major pharmaceutical companies. The authors report no other conflicts of interest in this work., (© 2024 Beeh et al.)

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE)., Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs)., Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p <0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p <0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p <0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers., Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance., Competing Interests: The authors declare the following conflicts of interest during the last 3 years in relation to this article: MS, ASI, NBG, and PWJ are employees of, and hold shares in, GlaxoSmithKline plc. ASI is also unpaid faculty at McMaster University, Canada. HBL is an employee of ICON plc. EMJ, SL, and HAD were employees of ICON plc. when the study was conducted. ICON plc. received GlaxoSmithKline plc. funding to conduct this study, but was not paid for the development of this manuscript. The authors report no other conflicts of interest in this work., (© 2020 Lewis et al.)

This paper estimates the annual direct medical and caregiver costs of Streptococcus pneumoniae (Sp) and nontypeable Haemophilus influenzae (NTHi)-associated diseases in children younger than 10 years in Canada, Germany, Mexico, and Norway after vaccination with the 7-valent pneumococcal conjugate vaccine (PCV-7). Per-episode direct medical costs for treating Sp- and NTHi-associated diseases were summarised from the literature for three countries, and a Delphi panel was used to estimate resource use and the per-episode costs for Mexico. Per-episode or annual costs were inflated to 2008 local currency and converted to 2008 United States (US) dollars using purchasing power parities. The analysis was for 1 year; therefore, costs were not discounted. Sp- and NTHi-associated diseases resulted in current annual national costs of $179-$260 million ($5.43-$7.89 per capita) in Canada, $290-$435 million ($3.53-$5.29 per capita) in Germany, $277-$432 million ($2.59-$4.05 per capita) in Mexico, and $20-$28 million ($4.35-$6.17 per capita) in Norway. Although acute otitis media (AOM) was associated with the lowest per-case costs, it accounted for between 45% and 88% of the national direct medical costs and between 67% and 96% of caregiver costs for Sp- and NTHi-associated diseases. Sp- and NTHi-associated diseases continue to result in substantial direct medical and caregiver costs despite current PCV-7 vaccination programs., (Copyright © 2010 Elsevier Ltd. All rights reserved.)