Rehospitalization risks and outcomes in COPD patients receiving maintenance pharmacotherapy
Respiratory Medicine, 04/23/2012
Dalal AA et al. – Patients receiving fluticasone propionate/salmeterol combination (FSC) as maintenance therapy following an initial COPD–related hospitalization or emergency department (ED) visit experienced better clinical and economic outcomes than patients receiving anticholinergic (AC). Methods
- In this retrospective, observational study using administrative claims data, the authors identified COPD patients age ≥40 years who received maintenance therapy within 30 days of an initial COPD–related hospitalization or ED visit with: (1) fluticasone propionate/salmeterol combination (FSC 250 mcg/50 mcg) as new therapy, or (2) an anticholinergic (AC; tiotropium or ipratropium with or without albuterol).
- The FSC and AC patients were matched (1:3 ratio) on various baseline characteristics using propensity scores to mitigate selection bias at baseline.
- The proportion of patients with COPD–related healthcare events, the mean event rates, and the mean costs in the subsequent 12 months were calculated.
- The FSC cohort (N = 484) had a significantly lower proportion of rehospitalized patients during follow–up than did the AC cohort (N = 1452), 3.1% versus 4.6% (P = 0.047).
- The mean number of rehospitalizations was 0.03 in the FSC cohort and 0.07 in the AC cohort (P = 0.001).
- The proportion of patients with an exacerbation resulting in an ED or physician–outpatient visit and the mean number of such visits did not differ between cohorts.
- Total annual COPD–related medical costs were lower for FSC than for AC ($2080 versus $2636, P = 0.006), with lower medical and higher pharmacy costs.