Differences in health care outcomes between postdischarge COPD patients treated with inhaled corticosteroid/long-acting β2-agonist via dry-powder inhalers and pressurized metered-dose inhalers

被引:4
作者
Wittbrodt, Eric T. [1 ]
Millette, Lauren A. [1 ]
Evans, Kristin A. [2 ]
Bonafede, Machaon [2 ]
Tkacz, Joseph [2 ]
Ferguson, Gary T. [3 ]
机构
[1] AstraZeneca, Med Affairs, 1800 Concord Pike, Wilmington, DE 19803 USA
[2] IBM Watson Hlth, Life Sci, Value Based Care, Cambridge, MA USA
[3] Pulm Res Inst Southeast Michigan, Farmington Hills, MI USA
来源
INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE | 2019年 / 14卷
关键词
COPD; inhaler; inhaled corticosteroid; long-acting beta(2)-agonist; utilization; costs; OBSTRUCTIVE PULMONARY-DISEASE; INSPIRATORY FLOW-RATE; COMBINATION THERAPY; ACUTE EXACERBATION; COST-EFFECTIVENESS; AMERICAN-COLLEGE; THORACIC SOCIETY; CHEST PHYSICIANS; RISK-FACTORS; ASTHMA;
D O I
10.2147/COPD.S177213
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Purpose: The aim of this study was to examine real-world differences in health care resource use (HRU) and costs among COPD patients in the USA treated with a dry powder inhaler (DPI) or pressurized metered-dose inhaler (pMDI) following a COPD-related hospitalization. Methods: This retrospective analysis used the Truven MarketScan (R) databases. Eligibility criteria included 1) age >= 40 years, 2) COPD diagnosis, 3) inpatient admission with a diagnosis of COPD exacerbation, 4) inhaled corticosteroid (ICS)/long-acting beta(2) -agonist (LABA) prescription within 10 days of hospital discharge (index date), and 5) continuous enrollment for 12 months preindex and 90 days postindex. Outcomes included pre-and postindex HRU and costs. DPI and pMDI groups were compared on postindex outcomes via multivariate models controlling for demographic and baseline characteristics. Results: The sample included 1,960 DPI and 1,086 pMDI ICS/LABA patients. During the preindex period, pMDI patients were significantly more likely to be prescribed a short-acting beta-agonist, experienced more COPD exacerbation-related hospital days, and had a greater number of pulmonologist visits compared to DPI patients (P<0.05), all suggestive of greater disease severity. However, multivariate models revealed that pMDI patients incurred 10% lower all-cause postindex costs (predicted mean costs [2016 US dollars]: $2,673 vs $2,956) and 19% lower COPD-related costs (predicted mean costs: $138 vs $ 169; P<0.05). Additionally, pMDI patients were 28% less likely to experience a COPD exacerbation-related hospital readmission within 60 days postdischarge compared to the DPI patients (OR: 0.72, 95% CI: 0.52-0.99, P<0.05). Conclusion: Despite greater COPD-related HRU and costs preceding index hospitalization, US patients using a pMDI after hospital discharge incurred significantly lower all-cause and COPD-related health care costs compared with those using a DPI, in addition to a decreased likelihood of a COPD exacerbation-related hospital readmission. Results suggest that inhaler device type may influence COPD outcomes and that COPD patients may derive greater clinical benefit from treatment delivered via pMDI vs DPI.
引用
收藏
页码:101 / 114
页数:14
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