Exacerbations, health services utilization, and costs in commercially-insured COPD patients treated with nebulized long-acting β2-agonists

Abstract

Objective:

This retrospective cohort study compared exacerbations, health services utilization, and costs among chronic obstructive pulmonary disease (COPD) patients who received nebulized arformoterol or nebulized formoterol therapy.

Methods:

Using PharMetrics Plus health plan claims, 417 nebulized long-acting β2-agonist (LABA) users meeting the study inclusion criteria were identified: had ≥2 fills of nebulized arformoterol or nebulized formoterol from January 1, 2009, to December 31, 2011, adhered to using their index drug ≥60% of the days during 1 year post-index, were ≥35 years old and continuously enrolled 180 days pre- and 1 year post-index, and did not use a nebulized LABA or have an asthma diagnosis during the pre-index period. Descriptive and multivariate analyses were performed.

Results:

A total of 274 nebulized arformoterol users and 143 nebulized formoterol users were identified with comparable demographic characteristics. However, significant differences were observed between the two groups in some clinical characteristics at index including comorbidities and use of antibiotics. At 1 year post-index, a lower proportion of nebulized arformoterol users had ≥1 exacerbation compared to nebulized formoterol users (70.4% vs 80.4%; p = 0.028). Among patients with ≥1 hospital admission, COPD-related costs per inpatient stay were significantly lower for nebulized arformoterol users than nebulized formoterol users (median = $9542 vs $14,025; p = 0.009). After controlling for confounders, nebulized arformoterol users had 19% marginally lower risk of exacerbations than nebulized formoterol users (hazard ratio = 0.81, 95% confidence interval = 0.64–1.03; p < 0.084) and 14.4% marginally lower COPD-related total costs at 1 year post-index (p = 0.062), primarily related to fewer hospital readmissions (7.6% vs 12.2%) and lower average costs per readmission stay (median = $7392 vs $18 081; p = 0.006).

Conclusions:

This study suggests that the choice of nebulized LABA may influence COPD-related exacerbation occurrence and costs. Future studies with larger and more closely matched nebulized arformoterol and nebulized formoterol users are needed to confirm these findings.

Keywords::

• COPD exacerbations
• Nebulized long-acting beta2-agonist
• Nebulized LABA
• Arformoterol
• Formoterol
• Hospitalizations
• Health services utilization

Transparency

Declaration of funding

Funding for this study was provided by Sunovion Pharmaceuticals, Inc.

Declaration of financial/other relationships

VB is a full-time employee of Sunovion Pharmaceuticals, Inc. and was involved with study design, data interpretation, revision of manuscript for important intellectual content, and approval of the final manuscript. At the time of this study, YJC and CM were both full-time employees of IMS Health, who were contracted by Sunovion Pharmaceuticals, Inc. to design the study and perform data analysis. Both contributed to the manuscript for important intellectual content and approved its final version. MN and BRC are affiliated with Advance Health Solutions LLC (AHS) as a full-time employee and senior consultant with expertise in pulmonary medicine serving on AHS’ Medical Advisory Board, respectively. Both performed data interpretation, revised the manuscript for important intellectual content, and approved its final version. AHS received funding for data interpretation and manuscript development from Sunovion Pharmaceuticals, Inc.

Acknowledgments

We wish to thank Soojin Cho-Reyes, PhD, and Leighla H. Sharghi, BSN, MPA from Advance Health Solutions LLC, for their assistance with literature review and synthesis as well as draft manuscript preparation.

Previous presentations

Selected content of this study was presented, in part, at the annual meetings of the International Society for Pharmacoeconomics and Outcomes Research held in Montreal, Quebec, Canada, May 31–June 4, 2014, and the American College of Chest Physicians held in Austin, TX, October 25–30, 2014.

Notes

† Brovana, Sunovion Pharmaceuticals, Inc., Marlborough, MA.

‡ Perforomist, Dey Pharma, L.P., Napa, CA.