Respiratory-related medical expenditure and inpatient utilisation among COPD patients receiving long-acting bronchodilator therapy

Abstract

Objective:

To evaluate chronic obstructive pulmonary disease (COPD)-related expenditure and hospitalisation in COPD patients treated with tiotropium versus alternative long-acting bronchodilators (LABDs).

Methods:

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.

Results:

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.

Conclusions:

Patients treated with tiotropim had lower COPD-related expenditures and risk of hospitalisation than patients treated with other LABDs

Key words::

• Claims data
• COPD
• Costs
• Long-acting bronchodilator therapy
• Utilisation

Transparency

Declaration of funding

This work was supported by Boehringer-Ingelheim Pharmaceuticals, Inc (BIPI) and Pfizer Inc. All authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and were fully responsible for all content and editorial decisions, and were involved at all stages of manuscript development.

Declaration of financial/other relationships

Z.C., E.D. and N.S. were all employees at Thomson Reuters at the time of manuscript development. Thomson Reuters provides custom consulting services to all major pharmaceutical companies. K.H.Z., R.P.-R. and C.L.B. are employees of Pfizer Inc. which co-sponsored this analysis. J.S. and H.S. are employees of BIPI which sponsored this study.

Acknowledgements

The authors wish to acknowledge the contributions of Boris Ivanov, who served as the primary SAS programmer. Liisa Palmer, PhD and Kathleen Wilson assisted with editing and formatting this manuscript.