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Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population.

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) exacerbations are associated with declining lung function and health-related quality of life, and increased hospitalization and mortality. Clinical trials often poorly represent the elderly and thus have only partial applicability to their clinical care.

OBJECTIVE

To compare exacerbations, COPD-related health care utilization (HCU), and costs in a predominantly elderly Medicare COPD population initiated on roflumilast versus those not initiated on roflumilast.

METHODS

Deidentified administrative claims data from a large, national payer were utilized. Medicare patients aged 40-89 years with at least one COPD diagnosis from May 1, 2010 to December 31, 2012 were included. Members with at least one roflumilast pharmacy claim (index) were assigned to the roflumilast group and those without were assigned to the non-roflumilast group. Proxy index dates for the non-roflumilast group were randomly assigned for similar distribution of all patients' time at risk. Subjects with at least one pre-index COPD exacerbation had to be continuously enrolled for ≥365 days pre-index and post-index. Unadjusted and adjusted difference-in-difference (DID) analyses contrasted pre-index with post-index changes in exacerbations, HCU, and costs of roflumilast treatment compared with non-roflumilast treatment.

RESULTS

A total of 500 roflumilast and 60,145 non-roflumilast patients were included (mean age 69.7 and 72.3 years, respectively; P<0.0001). Unadjusted DID favored roflumilast for all exacerbations, with greater pre-index to post-index reductions in mean per 30-day COPD-related hospitalizations (-0.0182 versus -0.0013, P=0.009), outpatient visits (-0.2500 versus -0.0606, P<0.0001), and COPD-related inpatient costs (-US$141 versus -US$11, P=0.0346) and outpatient costs (-US$31 versus -US$4, P<0.0001). Multivariate analyses identified significantly improved pre-index to post-index COPD-related total costs (P=0.0005) and total exacerbations (P<0.0001) for the roflumilast group versus non-roflumilast group.

CONCLUSION

In a predominantly elderly Medicare COPD population, newly initiated roflumilast patients displayed similar or significantly better unadjusted reductions in all exacerbation-related, COPD-related HCU-related, and COPD-related costs outcomes compared with non-roflumilast patients. These analyses also suggest better adjusted COPD-related costs and total exacerbations for roflumilast-initiated patients.

Authors+Show Affiliations

Comprehensive Health Insights, Inc., Humana, Louisville, KY, USA.Health Economics and Outcomes Research, Forest Laboratories, LLC, an affiliate of Actavis, Inc., Jersey City, NJ, USA.Comprehensive Health Insights, Inc., Humana, Louisville, KY, USA.Comprehensive Health Insights, Inc., Humana, Louisville, KY, USA.Department of Medicine, University of California-Irvine, Orange, CA, USA.

Pub Type(s)

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

Language

eng

PubMed ID

25834417

Citation

Moll, Keran, et al. "Impact of Roflumilast On Exacerbations of COPD, Health Care Utilization, and Costs in a Predominantly Elderly Medicare Advantage Population." International Journal of Chronic Obstructive Pulmonary Disease, vol. 10, 2015, pp. 565-76.
Moll K, Sun SX, Ellis JJ, et al. Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population. Int J Chron Obstruct Pulmon Dis. 2015;10:565-76.
Moll, K., Sun, S. X., Ellis, J. J., Howe, A., & Amin, A. (2015). Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population. International Journal of Chronic Obstructive Pulmonary Disease, 10, 565-76. https://doi.org/10.2147/COPD.S79025
Moll K, et al. Impact of Roflumilast On Exacerbations of COPD, Health Care Utilization, and Costs in a Predominantly Elderly Medicare Advantage Population. Int J Chron Obstruct Pulmon Dis. 2015;10:565-76. PubMed PMID: 25834417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population. AU - Moll,Keran, AU - Sun,Shawn X, AU - Ellis,Jeffrey J, AU - Howe,Andrew, AU - Amin,Alpesh, Y1 - 2015/03/16/ PY - 2015/4/3/entrez PY - 2015/4/4/pubmed PY - 2015/12/15/medline KW - COPD KW - Medicare KW - exacerbations KW - health care utilization KW - roflumilast SP - 565 EP - 76 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 10 N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with declining lung function and health-related quality of life, and increased hospitalization and mortality. Clinical trials often poorly represent the elderly and thus have only partial applicability to their clinical care. OBJECTIVE: To compare exacerbations, COPD-related health care utilization (HCU), and costs in a predominantly elderly Medicare COPD population initiated on roflumilast versus those not initiated on roflumilast. METHODS: Deidentified administrative claims data from a large, national payer were utilized. Medicare patients aged 40-89 years with at least one COPD diagnosis from May 1, 2010 to December 31, 2012 were included. Members with at least one roflumilast pharmacy claim (index) were assigned to the roflumilast group and those without were assigned to the non-roflumilast group. Proxy index dates for the non-roflumilast group were randomly assigned for similar distribution of all patients' time at risk. Subjects with at least one pre-index COPD exacerbation had to be continuously enrolled for ≥365 days pre-index and post-index. Unadjusted and adjusted difference-in-difference (DID) analyses contrasted pre-index with post-index changes in exacerbations, HCU, and costs of roflumilast treatment compared with non-roflumilast treatment. RESULTS: A total of 500 roflumilast and 60,145 non-roflumilast patients were included (mean age 69.7 and 72.3 years, respectively; P<0.0001). Unadjusted DID favored roflumilast for all exacerbations, with greater pre-index to post-index reductions in mean per 30-day COPD-related hospitalizations (-0.0182 versus -0.0013, P=0.009), outpatient visits (-0.2500 versus -0.0606, P<0.0001), and COPD-related inpatient costs (-US$141 versus -US$11, P=0.0346) and outpatient costs (-US$31 versus -US$4, P<0.0001). Multivariate analyses identified significantly improved pre-index to post-index COPD-related total costs (P=0.0005) and total exacerbations (P<0.0001) for the roflumilast group versus non-roflumilast group. CONCLUSION: In a predominantly elderly Medicare COPD population, newly initiated roflumilast patients displayed similar or significantly better unadjusted reductions in all exacerbation-related, COPD-related HCU-related, and COPD-related costs outcomes compared with non-roflumilast patients. These analyses also suggest better adjusted COPD-related costs and total exacerbations for roflumilast-initiated patients. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/25834417/Impact_of_roflumilast_on_exacerbations_of_COPD_health_care_utilization_and_costs_in_a_predominantly_elderly_Medicare_Advantage_population_ L2 - https://dx.doi.org/10.2147/COPD.S79025 DB - PRIME DP - Unbound Medicine ER -