• Anand A Dalal, Manan B Shah, Anna O D'Souza, Amol D Dhamane, and Glenn D Crater.
• GlaxoSmithKline, Research Triangle Park, NC, USA. anand.a.dalal@gsk.com
• Am J Manag Care. 2012 Sep 1; 18 (9): e338-45.

ObjectivesTo examine the impact of timing of maintenance treatment initiation (early vs delayed) on risk of future exacerbations and costs in chronic obstructive pulmonary disease (COPD) patients.Study DesignRetrospective cohort design using data (January 1, 2003, through June 30, 2009) from a large, US-based integrated pharmacy and medical claims database.MethodsAdministrative claims from January 1, 2003, through June 30, 2009, were used. Methotrexate (MTx)-naïve patients (aged >40 years) with at least 1 COPD-related hospitalization/emergency department (ED) visit were included (discharge date was index date). Patients initiating MTx within the first 30 days and 31 to 180 days post-index were classified into early and delayed cohorts, respectively. Clinical and economic outcomes related to COPD exacerbations were assessed for 1 year post-index and compared between cohorts using regression models controlling for baseline characteristics. The incremental effect on outcomes of every 30-day delay in MTx initiation up to 6 months after the index event was also assessed.ResultsThe majority of the 3806 patients (78.6%) received early MTx. A significantly higher proportion of patients in the delayed cohort had a COPD-related hospitalization/ED visit compared with the early cohort (25.6% vs 18.0%; P <.001). After controlling for baseline differences, the delayed cohort had a 43% (P <.001) higher risk of a future COPD-related hospitalization/ED visit compared with the early cohort. Every 30-day delay was associated with 9% risk increase (P = .002). Treatment delay also increased COPD-related costs ($5012 vs $3585; P <.001).ConclusionEarly MTx initiation is associated with reduced risk of future COPD exacerbations and lower costs.

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