To evaluate the relationship between long-acting bronchodilator (LABD) treatment type and COPD-related inpatient admission among commercially-insured COPD patients receiving LABD treatment.
A large US database of administrative claims (Thomson MarketScan) containing medical and pharmacy data of privately insured individuals, including those with Medicare supplemental coverage, was used to identify individuals aged 35 and older with COPD (ICD-9-CM 491.xx, 492.x, and 496) and at least one prescription claim for a LABD between July 1, 2004 and June 30, 2006. Patients were classified into 5 cohorts based on their index LABD regimen: monotherapy with tiotropium, salmeterol/fluticasone propionate, formoterol fumarate, salmeterol, or combination therapy with two or more LABDs. Demographic and clinical characteristics were evaluated for a six-month pre-period and COPD-related healthcare utilization was evaluated for a 12-month follow-up period. A multivariate logistic regression analysis was used to evaluate the relationship between LABD regimen and COPD-related inpatient admission, adjusting for demographic and pre-period clinical characteristics. Tiotropium monotherapy was the reference group. Odds ratios (OR) of other treatment regimens were computed as the exponential of the logistic regression coefficients. Values of p<0.05 were considered statistically significant.
Of 52,274 patients, 53% (n=27,457) were male and 71% (n=37,271) were 65 years or older. The regression model indicates that relative to patients treated with tiotropium at index, the likelihood of inpatient admission was higher for patients treated with each of the 4 alternative therapies. Compared with those treated with tiotropium, the odds of inpatient admission for the salmeterol/fluticasone cohort were 16% higher (OR=1.16, 95% CI=1.09–1.24), the odds for the salmeterol cohort 18% higher (OR=1.18, 95% CI=1.05–1.32), the odds for the formoterol fumarate cohort 24% higher (OR=1.24, 95% CI=1.06–1.45), and the odds for those receiving combination LABD therapy 34% higher (OR=1.34, 95% CI=1.23–1.45) (all p<0.01).
The likelihood of COPD-related inpatient admission varied by LABD treatment and was lowest for patients treated with tiotropium monotherapy.
COPD-related inpatient admission is a significant component of the cost of care for COPD.
Emily Durden, No Financial Disclosure Information; No Product/Research Disclosure Information