Levalbuterol compared to racemic albuterol: efficacy and outcomes in patients hospitalized with COPD or asthma.
OBJECTIVE
To compare clinical efficacy, patient outcomes, and medical costs in hospitalized patients treated with levalbuterol to those treated with racemic albuterol.


METHODS
Retrospective chart review.


METHODS
A 180-bed community hospital.


METHODS
Patients admitted to Halifax Regional Hospital with a diagnosis code for COPD or asthma from July 1 to December 31, 1998, and from July 1 to December 31, 1999, were eligible. In 1998, 125 patients were treated with nebulized racemic albuterol (2.5 mg q4h). In 1999, 109 patients were treated with levalbuterol (1.25 mg q8h).


RESULTS
Clinical efficacy was evaluated by the number of nebulizer treatments, improvement in symptoms and objective clinical findings, the length of hospital stay, and hospital discharge disposition. Medication and total hospital costs were calculated based on Red Book listings and Medicare reimbursement rates. Levalbuterol-treated patients required significantly fewer treatments with beta-agonists (mean [+/- SD] number of treatments, 19.0 +/- 12.7 vs 30.8 +/- 24.0; p < 0.001) and ipratropium bromide (mean number of treatments, 9.4 +/- 11.5 vs 23.2 +/- 25.1; p < 0.001) than did racemic albuterol-treated patients. The mean length of hospital stay in the levalbuterol group was almost 1 day less than that in the racemic albuterol group (4.7 +/- 2.9 vs 5.6 +/- 4.2 days, respectively; p < 0.058). Significantly more patients were readmitted to the hospital within 30 days in the racemic albuterol group compared with the levalbuterol group (16.4% vs 5.7%, respectively; p = 0.01). The mean total cost of nebulizer therapy was significantly greater for patients receiving racemic albuterol than for those receiving for levalbuterol ($112 +/- 101 vs $61 +/- 43, respectively; p < 0.001). The mean total hospital costs per patient were less for levalbuterol compared with racemic albuterol ($2756 +/- 2079 vs $3225 +/- 2714, respectively; p = 0.11). Regression analysis controlling for diagnosis, baseline FEV(1), and ipratropium use indicated that levalbuterol was associated with a length-of-stay savings of 0.91 days (p = 0.015), a total cost savings of $556 (p = 0.013), and a decrease in the likelihood of hospital readmission of 67% (p = 0.056).


CONCLUSIONS
Compared with patients treated with racemic albuterol, those treated with levalbuterol required less medication, had shorter lengths of hospital stay, had decreased costs for nebulizer therapy and hospitalization, and appeared to have a more prolonged therapeutic benefit. These findings support using levalbuterol as first-line therapy for hospitalized adults with COPD or asthma.
Truitt
Terrance
T
Halifax Regional Hospital, South Boston, VA, USA.
Witko
James
J
Halpern
Michael
M
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000420:Albuterol / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D000420:Albuterol