title: A comparison of the risk of hospitalizations due to chronicobstructive pulmonary disease in medicaid patients with various medication regimens, including ipratropium, inhaled corticosteroids, salmeterol, or their combination.
abstract: OBJECTIVE
  The aim of this study was to compare the risk of hospitalizations related to chronic obstructive pulmonary disease (COPD) among Medicaid patients prescribed various medication regimens.
  
  
  METHODS
  This was an observational, retrospective study set in the Texas Medicaid program. Eligible patients were aged 40 to 65 years, had a primary or secondary diagnosis of COPD, and had >/=1 prescription for ipratropium (IPR), inhaled corticosteroids (ICS), or salmeterol (SAL) between January 1, 1998, and August 31, 2000. Five index therapy groups were included in the risk analysis: IPR alone, ICS alone, SAL alone, ICS + IPR, and ICS + SAL.
  
  
  RESULTS
  A total of 4447 patients were included in the study (IPR alone, n = 2435; ICS alone, n = 1088; SAL alone, n = 299; ICS + IPR, n = 410; and ICS + SAL, n = 215). After adjusting for baseline characteristics, ICS + SAL was associated with a 35% lower risk of COPD-related hospitalization (hazard ratio [HR], 0.653 [95% CI, 0.428-0.997]) versus IPR alone. ICS alone was associated with a 16% lower risk (HR, 0.844 [95% CI, 0.693-1.028]) and SAL alone was associated with a 24% lower risk (HR, 0.756 [95% CI, 0.539-1.060]) versus IPR alone, but neither of these was statistically significant. There was no decrease in risk with ICS + IPR versus IPR alone (HR, 1.111 [95% CI, 0.870-1.420]). Variables that indicated increased risk were as follows: increasing age (HR, 1.015 [95% CI, 1.003-1.027]); number of preindex emergency department visits (HR, 1.189 [95% CI, 1.080-1.309]); number of preindex hospitalization visits (HR, 1.342 [95% CI, 1.220-1.477] ); number of nonrespiratory comorbid diagnoses (HR, 1.046 [95% CI, 1.012-1.081]); and having a diagnosis of influenza/pneumonia (HR, 1.276 [95% CI, 1.062-1.533]) or other respiratory diseases (HR, 1.356 [95% CI, 1.134-1.622]). Comorbid asthma was not associated with increased risk.
  
  
  CONCLUSIONS
  ICS + SAL was associated with a significantly lower risk of COPD-related hospitalization compared with IPR alone during the initial 12 months of therapy in a Medicaid population. Additional studies are needed to confirm these findings across different populations.
authors.affiliation: College of Pharmacy, University of Texas at Austin, Austin, Texas 78712-0127, USA. krascati@mail.utexas.edu
authors.forename: Karen L
authors.initials: KL
authors.lastname: Rascati
authors.forename: Richard H
authors.initials: RH
authors.lastname: Stanford
authors.forename: Rohit
authors.initials: R
authors.lastname: Borker
mesh_terms: D000280:Administration, Inhalation; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D000068299:Salmeterol Xinafoate
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids; D000068299:Salmeterol Xinafoate; D009241:Ipratropium; D000420:Albuterol