Hospitalizations comprise approximately 70% of the total COPD costs. Treatments that reduce the number of COPD related hospitalizations can lead to cost savings. The purpose of this analysis was to compare COPD hospitalization costs of various treatments..
Retrospective observational study of patients ≥ 45 years enrolled in 24 different managed care plans across the United States during 1997-2000 with a diagnosis of COPD (ICD-9-CM = 491.xx, 492.x, 496.xx). Subjects were classified into one of five therapy cohorts 1) ipratropium/albuterol (IPR), 2) salmeterol (SAL), 3) inhaled corticosteroid (ICS), 4) ICS + IPR and 5) ICS + SAL and followed for 12 months . Patients were excluded if they received cromolyn, theophylline, leukotriene modifers or had a COPD related hospitalization 12-months prior to their initial prescription. A two part regression model was used to compare COPD-related hospitalization costs in the follow-up period, adjusting for age, gender, concomitant asthma, managed care plan, baseline oral steroid, albuterol use and physician specialty.
3616 patients were identified, 1754 on IPR, 1032 on ICS, 357 on ICS + IPR, 266 on SAL and 207 on ICS + SAL. The adjusted COPD related hospitalization rate was significantly lower for ICS + SAL (8.3%, p<0.01) and ICS (10.4%, p<0.01), lower for SAL (12.7%, p=0.01) and higher for ICS + IPR (17.5%, p=0.68), compared to IPR (16.6%). The adjusted mean per patient hospitalization costs were lowest for ICS ($281 ± 148) followed by ICS + SAL ($359 ± 192) IPR ($509 ± 260), SAL ($510 ± 266) and ICS + IPR ($867 ± 441).
Because of significantly lower hospitalization rates, ICS and ICS + SAL had lower COPD related hospitalization costs compared to IPR, SAL, or ICS + IPR. Even though ICS + SAL had the lowest hospitalization rate, costs were lowest for ICS, suggesting that ICS + SAL had more severe COPD.
ICS and ICS + SAL as initial therapy may lead to reduced COPD related hospitalization costs.
R.H. Stanford, Employee of GlaxoSmithKline.