COPD has significant burden both in terms of morbidity/mortality as well as greater costs to managed care especially in elderly subjects. To examine cost-effectiveness of Fluticasone propionate/Salmeterol 250/50mcg fixed dose combination (FSC) over tiotropium (TIO) and other anticholinergics [(ACs), ipratropium (IPR) and ipratropium/albuterol combination (IPA)] in an elderly (> 65 years) commercial managed care population with chronic obstructive pulmonary disease (COPD).
In a retrospective cohort study conducted using administrative claims data, COPD subjects aged > 65 years enrolled in a commercial Medicare risk sharing plan (January 1, 2003 –December 31, 2005) were identified using diagnosis codes 491.xx, 492.xx, or 496.xx. We defined the following initial maintenance treatments FSC, IPA, IPR, TIO (mutually exclusive) determined by first use (index) of study drug. Outcomes were captured in the 12 months post index. Generalized Linear Models (log link and gamma distribution) calculated adjusted cost differences between FSC and other treatment arms (total, medical, IP/ED, outpatient, pharmacy) adjusting for demographics and baseline utilization.
14,689 subjects were identified with COPD (FSC=3,188, IPA = 6,385, IPR = 2,713, and TIO = 2,403). Unadjusted costs in the follow-up period) included total COPD-related costs; highest for IPR, at $4,289, as compared with $3,328.00 for TIO, $3,518 for IPA, and $3,210 for FSC250. Adjusted cost differences (compared to FSC): Total costs +$295 for IPA, +$1,235 for IPR, +$110 for TIO; Medical costs +$920 for IPA, +$1,965 for IPR, +$278 for TIO; Pharmacy costs −$398 for IPA, −$305 for IPR and −$169 for TIO (all p < 0.05).
In conclusion, FSC was found to be lest costly than IPR, IPA, or TIO on total cost, medical cost, IP/ED costs, and outpatient cost among those aged 65 and older. Alternatively, FSC pharmacy costs were greater than IPR, IPA, or TIO.
With increasing proportion of elderly demographics in USA and greater COPD prevalence, FSC has been shown as a viable option compared to ACs in reducing exacerbation while still being cost-effective.
Christopher Blanchette, University grant monies None; Grant monies (from sources other than industry) None; Grant monies (from industry related sources) None; Shareholder GlaxoSmithKline; Employee Employee of GlaxoSmithKline; Fiduciary position (of any organization, association, society, etc, other than ACCP None; Consultant fee, speaker bureau, advisory committee, etc. None; Other None; No Product/Research Disclosure Information