title: Assessing treatment effects of inhaled corticosteroids on medical expenses and exacerbations among COPD patients: longitudinal analysis of managed care claims.
abstract: OBJECTIVE
  To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Claims between 1997 and 2005 from a large managed care database.
  
  
  METHODS
  Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided.
  
  
  METHODS
  COPD patients aged 40 or older with > or = 15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed.
  
  
  RESULTS
  ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients > or = 50 years old, ICS was cost saving 57 percent of time.
  
  
  CONCLUSIONS
  ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates.
authors.affiliation: Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB# 7411, Chapel Hill, NC 27599-7411, USA.
authors.forename: Manabu
authors.initials: M
authors.lastname: Akazawa
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Biddle
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics* / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D004305:Dose-Response Relationship, Drug; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007345:Insurance Claim Review; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones