Economic assessment of initial maintenance therapy for chronic obstructive pulmonary disease.
ABSTRACT To compare the effects of initial maintenance therapy with fluticasone 250 microgram plus salmeterol 50 microgram in a single inhaler versus other inhaled medications on exacerbation risks and treatment costs among chronic obstructive pulmonary disease (COPD) patients.
A retrospective observational analysis was conducted by using medical/pharmacy claims from a large managed care database between January 2000 and February 2004. Patients age 40 years or older with a primary diagnosis of COPD (International Classification of Diseases, Ninth Revision, Clinical Modification code 490, 491, 492, or 496), at least 18 months of continuous eligibility, and an index prescription for fluticasone/salmeterol combination, salmeterol alone, inhaled corticosteroid alone, ipratropium/albuterol combination, or ipratropium alone (reference) were identified.
Time to first COPD-related hospitalization or emergency department (ED) visit was estimated by using Cox proportional hazard models. All-cause and COPD-related treatment costs were estimated by using generalized linear models with a gamma distribution and log link. Multivariable regressions were used, controlling for age, sex, comorbidities, COPD subtype, preindex medications, and hospitalizations and ED visits.
Initial maintenance therapy with fluticasone/salmeterol combination was associated with a 31% to 56% lower risk of hospitalization or ED visit compared with ipratropium alone, adjusting for baseline characteristics and preindex resource utilization. Fluticasone/salmeterol combination therapy was related to lower medical costs, higher pharmacy costs, and almost similar total costs in all populations studied.
Fluticasone/salmeterol combination therapy was considered to be cost-effective compared with ipratropium alone because it achieved better clinical outcomes with similar or lower treatment costs.
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ABSTRACT: To compare the effectiveness of budesonide/formoterol fumarate dihydrate (BFC) and fluticasone propionate/salmeterol (FSC), two combination inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) products approved for the treatment of chronic obstructive pulmonary disease (COPD) in the US with respect to cost, therapy adherence, and related healthcare utilization. The effectiveness of these two treatments has not previously been compared in a US COPD population. A retrospective cohort study assessed COPD-related outcomes using administrative claims data among ICS/LABA-naïve patients. Patients initiating BFC were propensity matched to FSC patients. Cost and effectiveness were measured as total healthcare expenditures, exacerbation events (hospitalizations, emergency department visits, or outpatient visits associated with oral corticosteroid or antibiotic prescription fills), and treatment medication adherence. Differences in COPD symptom control were assessed via proxy measure through claims for rescue medications and outpatient encounters. Of the 6770 patients (3385 BFC and 3385 FSC), fewer BFC patients had claims for short-acting beta agonists (SABA) (34.7% vs 39.5%; p<0.001) and ipratropium (7.8% vs 9.8%, p<0.005) than FSC patients, but no substantial differences were seen in other clinical outcomes including tiotropium or nebulized SABA claims, COPD-related outpatient visits, or exacerbation events. There were no significant differences in total COPD-related medical costs in the 6-month period after initiation of combination therapy. This was a retrospective observational study using claims data and accuracy of COPD diagnoses could not be verified, nor was information available on severity of disease. The results and conclusions of this study are limited to the population observed and the operational definitions of the study variables. For most outcomes of interest, BFC and FSC showed comparable real-world effectiveness.Journal of Medical Economics 09/2011; 14(6):769-76.
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ABSTRACT: Some treatments for chronic obstructive pulmonary disease (COPD) can reduce exacerbations, and thus could have a favourable impact on overall healthcare costs. To evaluate a new method for assessing the potential cost savings of COPD controller medications based on the incidence of exacerbations and their related resource utilization in the general population. Patients with COPD (n = 1074) enrolled in a regional managed care system in the US were identified using administrative data and divided by their medication use into three groups (salbutamol, ipratropium and salmeterol). Exacerbations were captured using International Classification of Diseases, Ninth Edition (ICD-9) and current procedural terminology (CPT) codes, then logistic regression models were created that described the risk of exacerbations for each comparator group and exacerbation type over a 6-month period. A Monte Carlo simulation was then applied 1000 times to provide the range of potential exacerbation reductions and cost consequences in response to a range of hypothetical examples of COPD controller medications. Exacerbation events for each group could be modelled such that the events predicted by the Monte Carlo estimates were very close to the actual prevalences. The estimated cost per exacerbation avoided depended on the incidence of exacerbation in the various subpopulations, the assumed relative risk reduction, the projected daily cost for new therapy, and the costs of exacerbation treatment. COPD exacerbation events can be accurately modelled from the healthcare utilization data of a defined cohort with sufficient accuracy for cost-effectiveness analysis. Treatments that reduce the risk or severity of exacerbations are likely to be cost effective among those patients who have frequent exacerbations and hospitalizations.PharmacoEconomics 01/2010; 28(9):733-49. · 2.86 Impact Factor
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ABSTRACT: To evaluate chronic obstructive pulmonary disease (COPD)-related expenditure and hospitalisation in COPD patients treated with tiotropium versus alternative long-acting bronchodilators (LABDs). Data were from the Thomson Reuters MarketScan Research Databases. COPD patients ≥ 35 years with at least one LABD claim between July 1, 2004 and June 30, 2006 were classified into five cohorts based on index LABD: monotherapy with tiotropium, salmeterol/fluticasone propionate, formoterol fumarate, or salmeterol or combination therapy. Demographic and clinical characteristics were evaluated for a 6-month pre-period and COPD-related utilisation and total costs were evaluated for a 12-month follow-up period. LABD relationship to COPD-related costs and hospitalisations were estimated by multivariate generalised linear modelling (GLM) and multivariate logistic regression, respectively. Of 52,274 patients, 53% (n = 27,457) were male, 71% (n = 37,271) were ≥ 65 years, and three LABD cohorts accounted for over 90% of the sample [53% (n = 27,654) salmeterol/fluticasone propionate, 23% (n = 11,762) tiotropium, and 15% (n = 7755) combination therapy]. Patients treated with salmeterol/fluticasone propionate (p < 0.001), formoterol fumarate (p = 0.032), salmeterol (p = 0.004), or with combination therapy (p < 0.001) had higher COPD-related costs and a greater risk of inpatient admission (p < 0.01 for all) versus tiotropium. Limitations: These data are based on administrative claims and as such do not include clinical information or information on risk factors, like smoking status, that are relevant to this population. Patients treated with tiotropim had lower COPD-related expenditures and risk of hospitalisation than patients treated with other LABDs.Journal of Medical Economics 02/2011; 14(2):147-58.