Hospital and emergency department utilization associated with treatment for chronic obstructive pulmonary disease in a managed-care Medicare population

Abstract

Background:

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with high morbidity and mortality among older and disabled adults. Few studies have examined the comparative effectiveness of maintenance therapies for chronic obstructive pulmonary disease (COPD) in this vulnerable population.

Objectives:

The study aims to compare healthcare resource utilization associated with hospitalization or emergency department (ED) visits between FDA-approved inhaled corticosteroid/long-acting β-agonist combinations [fluticasone propionate 250 µg/salmeterol 50 µg combination (FSC)] and anticholinergic treatments (ATC) in managed-care Medicare beneficiaries with COPD.

Research design and methods:

Data from the Integrated Health Care Information Systems (IHCIS) National Managed Care Benchmark Database was used in this retrospective, observational cohort study. The cohort consisted of managed-care Medicare beneficiaries with a diagnosis of COPD [International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM) codes 491.xx, 492.xx, or 496.xx] without evidence of comorbid asthma (ICD-9-CM 493.xx) who received treatment with FSC or ATC between 2003 and 2005. Cox proportional hazards regression models were conducted to examine the risk of all-cause and COPD-related hospitalizations and emergency department (ED) visits.

Results:

COPD patients treated with FSC had a 18% lower risk of a COPD-related hospitalization (HR = 0.82; 95% CI = 0.75, 0.89) and an ED visit (HR = 0.82; 95% CI = 0.76, 0.89) compared to patients treated with ATC. Findings were similar for all-cause utilization (hospitalization HR = 0.83; 95% CI = 0.78, 0.88; ED visit HR = 0.84; 95% CI = 0.80, 0.88).

Conclusions:

FSC is associated with a lower risk of COPD-related exacerbation events relative to ATC in managed-care Medicare beneficiaries with COPD. Findings from this study are only generalizable to managed-care Medicare beneficiaries residing in the community.

Key words: :

• Anticholinergic
• Chronic obstructive pulmonary disease
• Effectiveness
• Fluticasone
• Hospitalization
• Medicare
• Salmeterol

Transparency

Declaration of funding

This study was funded by GlaxoSmithKline.

Declaration of financial/other relationships

L.S-W. has disclosed that she has received consultancies from GlaxoSmithKline and that she is principle investigator of this study. C.M.B. has disclosed that he has received consultancies from GlaxoSmithKline, AstraZeneca, Sepracor, NovoNordisk and Viostat, as well as research support from GlaxoSmithKline, AstraZeneca and Amgen. A.A.D. has disclosed that he is an employee of, and owns shares in, GlaxoSmithKline. L.Z., J.Q. and H.K.Y. have nothing to disclose.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors have disclosed that they had no outside editorial assistance in preparing this manuscript.