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: This retrospective cohort study compared the risks of exacerbations and COPD-related healthcare costs between patients with chronic obstructive pulmonary disease (COPD) initiating tiotropium (TIO) alone and patients initiating triple therapy with fluticasone-salmeterol combination (FSC) added to TIO. Managed-care enrollees who had an index event of ≥ 1 pharmacy claim for TIO during the study period (January 1, 2003-April 30, 2008) and met other eligibility criteria were categorized into one of two cohorts depending on their medication use. Patients in the TIO+FSC cohort had combination therapy with TIO and FSC, defined as having an FSC claim on the same date as the TIO claim. Patients in the TIO cohort had no such FSC use. The risks of COPD exacerbations and healthcare costs were compared between cohorts during 1 year of follow-up. The sample comprised 3333 patients (n = 852 TIO+FSC cohort, n = 2481 TIO cohort). Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation (hazard ratio 0.772; 95% confidence interval [CI] 0.641, 0.930) and any exacerbation (hazard ratio 0.763; 95% CI 0.646, 0.949) and a nonsignificant reduction in COPD-related adjusted monthly medical costs. Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation and any exacerbation over a follow-up period of up to 1 year. These improvements were gained with triple therapy at roughly equal cost of that of TIO alone.Respiratory research 02/2012; 13:15. · 3.38 Impact Factor
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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. · 1.67 Impact Factor
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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 - J GEOCHEM EXPLOR. 11/2008; 102(1).