Tags

Type your tag names separated by a space and hit enter

Healthcare use and costs in patients with chronic bronchitis initiating maintenance therapy with fluticasone/salmeterol vs other inhaled maintenance therapies.
Curr Med Res Opin. 2009 Jan; 25(1):1-13.CM

Abstract

OBJECTIVE

To compare risk of hospitalization or emergency department (ED) visit and healthcare costs in patients with chronic bronchitis initiating inhaled maintenance therapy with fluticasone propionate/salmeterol 250/50 mcg combination (FSC) versus other inhaled maintenance therapies.

DESIGN AND METHODS

This retrospective cohort study assessed 9,217 patients from the PharMetrics administrative claims database enrolled from July 1997 to January 2005. Study subjects were persons with medical claims with diagnoses of chronic bronchitis (ICD-9-CM 491.xx) who also had pharmacy claims for FSC, salmeterol (SAL), inhaled corticosteroid (ICS), ipratropium (IPR), or ipratropium/albuterol combination (IAC). Persons with <12 months of continuous eligibility after the first prescription for initial maintenance therapy ("index date") were excluded as were those receiving fluticasone propionate/salmeterol 100/50 mcg or 500/50 mcg (not indicated for patients with chronic bronchitis). For remaining persons, time to first hospitalization or ED visit during follow-up was compared for those receiving FSC versus other therapies using Cox proportional hazards regression. Healthcare costs during the first 12 months of follow-up were analyzed using generalized linear model regression.

RESULTS

Receipt of FSC as initial inhaled maintenance therapy for chronic bronchitis (n = 1361) was associated with 41% lower risk of COPD-related hospitalization or ED visit compared with IPR (n < 1316) (p < 0.001). Adjusted costs of COPD-related hospitalization/ED visit were $507 (95% CI $218-$1083) less with FSC than IPR. However, patients receiving FSC had $261 (95% CI $205-$322) higher COPD-related pharmacy costs than those receiving IPR. Total COPD-related costs were $90 lower with FSC than IPR although this difference was not significant (95% CI $330-$443). Compliance, as measured by medication possession ratio, was 12% greater with FSC compared with IPR (p < 0.05). Comparisons of FSC with IAC yielded generally similar results. The limitations of the study are similar to those of other observational studies of secondary data regarding potential misclassification and omitted variable bias and residual confounding.

CONCLUSIONS

In persons with chronic bronchitis, initial maintenance therapy with FSC 250/50 mcg was associated with improved outcomes versus ipratropium-based therapy and although FSC was associated with greater pharmacy costs, it did not significantly increase total costs of COPD-related care.

Authors+Show Affiliations

Policy Analysis Inc. (PAI), Brookline, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19210134

Citation

Delea, Thomas E., et al. "Healthcare Use and Costs in Patients With Chronic Bronchitis Initiating Maintenance Therapy With Fluticasone/salmeterol Vs Other Inhaled Maintenance Therapies." Current Medical Research and Opinion, vol. 25, no. 1, 2009, pp. 1-13.
Delea TE, Hagiwara M, Dalal AA, et al. Healthcare use and costs in patients with chronic bronchitis initiating maintenance therapy with fluticasone/salmeterol vs other inhaled maintenance therapies. Curr Med Res Opin. 2009;25(1):1-13.
Delea, T. E., Hagiwara, M., Dalal, A. A., Stanford, R. H., & Blanchette, C. M. (2009). Healthcare use and costs in patients with chronic bronchitis initiating maintenance therapy with fluticasone/salmeterol vs other inhaled maintenance therapies. Current Medical Research and Opinion, 25(1), 1-13. https://doi.org/10.1185/03007990802534020
Delea TE, et al. Healthcare Use and Costs in Patients With Chronic Bronchitis Initiating Maintenance Therapy With Fluticasone/salmeterol Vs Other Inhaled Maintenance Therapies. Curr Med Res Opin. 2009;25(1):1-13. PubMed PMID: 19210134.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Healthcare use and costs in patients with chronic bronchitis initiating maintenance therapy with fluticasone/salmeterol vs other inhaled maintenance therapies. AU - Delea,Thomas E, AU - Hagiwara,May, AU - Dalal,Anand A, AU - Stanford,Richard H, AU - Blanchette,Christopher M, PY - 2009/2/13/entrez PY - 2009/2/13/pubmed PY - 2009/4/15/medline SP - 1 EP - 13 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 25 IS - 1 N2 - OBJECTIVE: To compare risk of hospitalization or emergency department (ED) visit and healthcare costs in patients with chronic bronchitis initiating inhaled maintenance therapy with fluticasone propionate/salmeterol 250/50 mcg combination (FSC) versus other inhaled maintenance therapies. DESIGN AND METHODS: This retrospective cohort study assessed 9,217 patients from the PharMetrics administrative claims database enrolled from July 1997 to January 2005. Study subjects were persons with medical claims with diagnoses of chronic bronchitis (ICD-9-CM 491.xx) who also had pharmacy claims for FSC, salmeterol (SAL), inhaled corticosteroid (ICS), ipratropium (IPR), or ipratropium/albuterol combination (IAC). Persons with <12 months of continuous eligibility after the first prescription for initial maintenance therapy ("index date") were excluded as were those receiving fluticasone propionate/salmeterol 100/50 mcg or 500/50 mcg (not indicated for patients with chronic bronchitis). For remaining persons, time to first hospitalization or ED visit during follow-up was compared for those receiving FSC versus other therapies using Cox proportional hazards regression. Healthcare costs during the first 12 months of follow-up were analyzed using generalized linear model regression. RESULTS: Receipt of FSC as initial inhaled maintenance therapy for chronic bronchitis (n = 1361) was associated with 41% lower risk of COPD-related hospitalization or ED visit compared with IPR (n < 1316) (p < 0.001). Adjusted costs of COPD-related hospitalization/ED visit were $507 (95% CI $218-$1083) less with FSC than IPR. However, patients receiving FSC had $261 (95% CI $205-$322) higher COPD-related pharmacy costs than those receiving IPR. Total COPD-related costs were $90 lower with FSC than IPR although this difference was not significant (95% CI $330-$443). Compliance, as measured by medication possession ratio, was 12% greater with FSC compared with IPR (p < 0.05). Comparisons of FSC with IAC yielded generally similar results. The limitations of the study are similar to those of other observational studies of secondary data regarding potential misclassification and omitted variable bias and residual confounding. CONCLUSIONS: In persons with chronic bronchitis, initial maintenance therapy with FSC 250/50 mcg was associated with improved outcomes versus ipratropium-based therapy and although FSC was associated with greater pharmacy costs, it did not significantly increase total costs of COPD-related care. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/19210134/Healthcare_use_and_costs_in_patients_with_chronic_bronchitis_initiating_maintenance_therapy_with_fluticasone/salmeterol_vs_other_inhaled_maintenance_therapies_ L2 - https://www.tandfonline.com/doi/full/10.1185/03007990802534020 DB - PRIME DP - Unbound Medicine ER -