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: We examined the copper isotope ratio of primary high temperature Cu-sulfides, secondary low temperature Cu-sulfides (and Cu-oxides) as well as Fe-oxides in the leach cap, which represent the weathered remains of a spectrum of Cu mineralization, from nine porphyry copper deposits. Copper isotope ratios are reported as δ 65 Cu‰ = ((65 Cu/ 63 Cu sample / 65 Cu/ 63 Cu NIST 976 standard) − 1) ⁎ 10 3 . Errors for all the analyses are ± 0.14‰ (determined by multiple analyses of the samples) and mass bias was corrected through standard-sample-standard bracketing. The overall isotopic variability measured in these samples range from − 16.96‰ to 9.98‰. Distinct Cu isotopic reservoirs exist for high temperature hypogene, enrichment, and leach cap minerals. Chalcopyrite from high temperature primary mineralization forms a relatively tight cluster of δ 65 Cu values of 1‰ to − 1‰ whereas secondary minerals formed by low temperature reveal a range of δ 65 Cu values from − 16.96‰ to 9.98‰. Secondary chalcocite is relatively heavy with δ 65 Cu varying from − 0.3‰ to 6.5‰. Leach cap minerals dominated by Fe-oxides (jarosite, hematite and goethite) are relatively light ranging from − 9.9‰ to 0.14‰. Although the dataset is relatively small (n = 50 total minerals analyzed), a combination of these data with values from previously published reports [Zhu, X.., 2000. Determination of natural Cu-isotope variation by plasma-source mass spectrometry; implications for use as geochemical tracers. Chemical Geology, 163(1–4): 139–149.; Larson et al., 2003; Mathur, R. et al., 2005. Cu isotopic fractionation in the supergene environment with and without bacteria. Geochimica et Cosmochimica Acta, 69(22): 5233–5246.; Markl et al., 2006, and Maher et al., 2007], show a distinct pattern of heavier isotopic signature in supergene samples and a lighter isotopic signature exists in the leach cap and oxidation zone minerals. The pattern could be used as a tool for exploration geology by providing the following information: 1) Identification of highly fractionated copper isotope ratios in copper sulfide and Fe-oxide samples that indicate supergene processes and the extent of leaching and enrichment copper 2) Identification of highly fractionated copper isotope ratios in surface and/or groundwaters that indicate the active weathering copper sulfides that experienced significant enrichment.Journal of Geochemical Exploration 11/2008; 102(1). DOI:10.1016/j.gexplo.2008.09.004 · 2.43 Impact Factor
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ABSTRACT: Although maintenance medications are a cornerstone of chronic obstructive pulmonary disease (COPD) management, adherence remains suboptimal. Poor medication adherence is implicated in poor outcomes with other chronic conditions; however, little is understood regarding links between adherence and outcomes in COPD patients. This study investigates the association of COPD maintenance medication adherence with hospitalization and health care spending. Using the 2006 to 2007 Chronic Condition Warehouse administrative data, this retrospective cross-sectional study included 33,816 Medicare beneficiaries diagnosed with COPD who received at least 2 prescriptions for ≥1 COPD maintenance medications. After a 6-month baseline period (January 1, 2006 to June 30, 2006), beneficiaries were followed through to December 31, 2007 or death. Two medication adherence measures were assessed: medication continuity and proportion of days covered (PDC). PDC values ranged from 0 to 1 and were calculated as the number of days with any COPD maintenance medication divided by duration of therapy with these agents. The association of adherence with all-cause hospital events and Medicare spending were estimated using negative binomial and γ generalized linear models, respectively, adjusting for sociodemographics, Social Security disability insurance status, low-income subsidy status, comorbidities, and proxy measures of disease severity. Improved adherence using both measures was significantly associated with reduced rate of all-cause hospitalization and lower Medicare spending. Patients who continued with their medications had lower hospitalization rates (relative rate [RR] = 0.88) and lower Medicare spending (-$3764), compared with patients who discontinued medications. Similarly, patients with PDC ≥0.80 exhibited lower hospitalization rates (RR = 0.90) and decreased spending (-$2185), compared with patients with PDC <0.80. COPD patients with higher adherence to prescribed regimens experienced fewer hospitalizations and lower Medicare costs than those who exhibited lower adherence behaviors. Findings suggested the clinical and economic importance of medication adherence in the management of COPD patients in the Medicare population.04/2012; 10(3):201-10. DOI:10.1016/j.amjopharm.2012.04.002
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) imposes a significant and growing economic burden on the US health care system. A brief exploration of reviews on the therapeutic management of COPD reveals a range of pharmacologic and nonpharmacologic options for reducing deleterious and costly exacerbations. Consensus is that both forms of therapy provide the greatest benefit to all patients. However, prescribing physicians must account for availability of resources and patients' ability to pay, as well as patient response and their likely persistence or adherence to recommended therapies. The ongoing challenge is to overcome barriers to comprehensive, real-world economic evaluations in order to establish the most cost-effective mix of therapies for every patient in the heterogeneous COPD population. Only then can evidence-based guidelines be translated into the most cost-effective delivery of care.Expert Review of Pharmacoeconomics & Outcomes Research 12/2012; 12(6):725-31. DOI:10.1586/erp.12.69 · 1.67 Impact Factor