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.

Abstract

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® 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 β2-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 β-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.

• Authors: Eric T Wittbrodt, Lauren A Millette, Kristin A Evans, Machaon Bonafede, Joseph Tkacz, Gary T Ferguson
• Journal: International journal of chronic obstructive pulmonary disease (Int J Chron Obstruct Pulmon Dis) 2019 Vol. 14 Pg. 101-114 ISSN: 1178-2005 [Electronic] New Zealand
• PMID: 30613140 (Publication Type: Comparative Study, Journal Article, Observational Study)

Chemical References

• Adrenal Cortex Hormones
• Adrenergic beta-2 Receptor Agonists
• Drug Combinations

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (administration & dosage, adverse effects, economics)
• Adrenergic beta-2 Receptor Agonists (administration & dosage, adverse effects, economics)
• Adult
• Aged
• Clinical Decision-Making
• Cost-Benefit Analysis
• Databases, Factual
• Disease Progression
• Drug Combinations
• Drug Costs
• Dry Powder Inhalers
• Female
• Hospital Costs
• Humans
• Lung (drug effects, physiopathology)
• Male
• Metered Dose Inhalers
• Middle Aged
• Patient Discharge (economics)
• Patient Readmission
• Pulmonary Disease, Chronic Obstructive (diagnosis, drug therapy, economics, physiopathology)
• Retrospective Studies
• Time Factors
• Treatment Outcome
• United States