Comparison of resource use by COPD patients on inhaled therapies with long-acting bronchodilators: a database study

• Published in: BMC pulmonary medicine 2011-12, Vol.11 (1), p.61-61, Article 61
• Main Authors: Kozma, Chris M, Paris, Andrew L, Plauschinat, Craig A, Slaton, Terra, Mackowiak, John I
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Aged; Analysis; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - economics; Clinical medicine; Corticosteroids; Costs; Databases, Factual; Delayed-Action Preparations - administration & dosage; Female; Follow-Up Studies; Health Care Costs; Health economics; Humans; Lung diseases; Lung diseases, Obstructive; Male; Medical care; Medical care, Cost of; Medical research; Medicine, Experimental; Middle Aged; Mortality; Pharmaceuticals; Prescriptions; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - economics; Pulmonology; Quality of life; Respiratory agents; Respiratory Therapy - economics; Retrospective Studies; Steroids; Studies; Utilization
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/1471-2466-11-61

The purpose of this analysis was to compare health care costs and utilization among COPD patients who had long-acting beta-2 agonist (LABA) OR long-acting muscarinic antagonist (LAMA); LABA AND LAMA; or LABA, LAMA, AND inhaled corticosteroid (ICS) prescription claims. This was a 12 month pre-post, retrospective analysis using COPD patients in a national administrative insurance database. Propensity score and exact matching were used to match patients 1:1:1 between the LABA or LAMA (formoterol, salmeterol, or tiotropium), LABA and LAMA (tiotropium/formoterol or tiotropium/salmeterol), and LABA, LAMA and ICS (bronchodilators plus steroid) groups. Post-period comparisons were evaluated with analysis of covariance. Costs were evaluated from a commercial payer perspective. A total of 523 patients were matched using 29 pre-period variables (e.g., demographics, medication exposure). Post-match assessments indicated balance among the cohorts. COPD-related costs differed among groups (LABA or LAMA $2,051 SE = 91; LABA and LAMA $2,823 SE = 62; LABA, LAMA and ICS $3,546 SE = 89; all p < .0001) with the differences driven by study medication costs. However, non-study COPD medication costs were higher for the LABA or LAMA therapy group ($911 SE = 91) compared to the LABA and LAMA therapy group ($668 SE = 58; p = 0.0238) and non-study respiratory medications were approximately $100 greater for the LABA or LAMA therapy group relative to both LABA and LAMA (p = .0018) and LABA, LAMA, and ICS (p = .0071) therapy groups. While there was no observed difference in outpatient costs, there was a slightly higher number of outpatient visits per patient in the LABA and LAMA (25.5 SE = 0.9, p = 0.0070) relative to the LABA or LAMA therapy group (22.3 SE = 0.8) and higher utilization (89.7% of patients) with COPD visits in the LABA and LAMA therapy group relative to both the LABA or LAMA (73.8%; p < .0001) and LABA, LAMA and ICS therapy groups (85.3; p = 0.0305). Significant cost differences driven mainly by pharmaceuticals were observed among LABA or LAMA, LABA and LAMA and LABA, LAMA and ICS therapies. A COPD-related cost offset was observed from single bronchodilator to two bronchodilators. Addition of an ICS with two bronchodilators resulted in higher treatment costs without reduction in other COPD-related costs compared with two bronchodilators.