A new method for examining the cost savings of reducing COPD exacerbations.
BACKGROUND
Some treatments for chronic obstructive pulmonary disease (COPD) can reduce exacerbations, and thus could have a favourable impact on overall healthcare costs.


OBJECTIVE
To evaluate a new method for assessing the potential cost savings of COPD controller medications based on the incidence of exacerbations and their related resource utilization in the general population.


METHODS
Patients with COPD (n = 1074) enrolled in a regional managed care system in the US were identified using administrative data and divided by their medication use into three groups (salbutamol, ipratropium and salmeterol). Exacerbations were captured using International Classification of Diseases, Ninth Edition (ICD-9) and current procedural terminology (CPT) codes, then logistic regression models were created that described the risk of exacerbations for each comparator group and exacerbation type over a 6-month period. A Monte Carlo simulation was then applied 1000 times to provide the range of potential exacerbation reductions and cost consequences in response to a range of hypothetical examples of COPD controller medications.


RESULTS
Exacerbation events for each group could be modelled such that the events predicted by the Monte Carlo estimates were very close to the actual prevalences. The estimated cost per exacerbation avoided depended on the incidence of exacerbation in the various subpopulations, the assumed relative risk reduction, the projected daily cost for new therapy, and the costs of exacerbation treatment.


CONCLUSIONS
COPD exacerbation events can be accurately modelled from the healthcare utilization data of a defined cohort with sufficient accuracy for cost-effectiveness analysis. Treatments that reduce the risk or severity of exacerbations are likely to be cost effective among those patients who have frequent exacerbations and hospitalizations.
Mapel
Douglas W
DW
Lovelace Clinic Foundation, Albuquerque, New Mexico 87106-4264, USA. Doug.Mapel@LCFresearch.org
Schum
Michael
M
Lydick
Eva
E
Marton
Jeno P
JP
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use*; D003198:Computer Simulation; D017046:Cost Savings / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D009241:Ipratropium / Q000191:economics / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D009516:New Mexico; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D000068299:Salmeterol Xinafoate; D012621:Seasons; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D009241:Ipratropium; D000420:Albuterol
Clin Ther. 2003 Jan;25(1):285-97
12637127
Eur Respir J. 2002 Feb;19(2):217-24
11866001
Lancet. 2003 Feb 8;361(9356):449-56
12583942
Respir Med. 2007 Nov;101(11):2312-20
17681461
Respir Med. 2004 Feb;98(2):99-107
14971871
Ann Intern Med. 2007 Apr 17;146(8):545-55
17310045
Eur J Health Econ. 2007 Jun;8(2):123-35
17370096
Value Health. 2004 Mar-Apr;7(2):153-67
15164805
Respir Med. 2008 Mar;102(3):413-21
18086519
Respir Med. 2008 Aug;102(8):1099-108
18614347
Ann Intern Med. 2005 Sep 6;143(5):317-26
16144890
J Clin Epidemiol. 1992 Jun;45(6):613-9
1607900
Eur Respir J. 2002 Feb;19(2):209-16
11871363
Lancet. 1998 Mar 14;351(9105):773-80
9519948
Thorax. 2003 May;58(5):399-404
12728159
Can Respir J. 2007 Apr;14(3):145-52
17464378
Respir Med. 2003 Mar;97(3):212-20
12645827
Arch Intern Med. 2000 Sep 25;160(17):2653-8
10999980
Value Health. 2008 Jul-Aug;11(4):628-36
18194402
Am J Respir Crit Care Med. 2007 Jan 15;175(2):144-9
17053207
Respir Med. 2009 Mar;103(3):373-8
19013781
Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55
17507545
Pharmacoeconomics. 2005;23(6):619-37
15960557
Respir Med. 2004 Sep;98(9):883-91
15338802
Respir Med. 2009 Jan;103(1):12-21
19010652
Thorax. 2006 Feb;61(2):122-8
16443706
Lancet. 1999 May 29;353(9167):1819-23
10359405
Respir Med. 2002 Sep;96(9):700-8
12243316
Eur Respir J. 2004 Jun;23(6):932-46
15219010
Health Serv Res. 2008 Dec;43(6):2164-82
18671750
Eur Respir J. 2003 Dec;22(6):912-9
14680078
Can Respir J. 2002 May-Jun;9(3):178-85
12068339
Chest. 2000 May;117(5 Suppl 2):398S-401S
10843984
Am J Manag Care. 2008 Jul;14(7):438-48
18611095
N Engl J Med. 2005 Oct 6;353(14):1516-22
16207857
Chest. 1999 Apr;115(4):957-65
10208192
Ann Intern Med. 2008 Jun 17;148(12):956-61
18483128
Chest. 2007 Jan;131(1):20-8
17218552
Pharmacoeconomics. 2004;22(11):741-9
15250751
BMJ. 2000 May 13;320(7245):1297-303
10807619
Chest. 2006 Jun;129(6):1693-708
16778291
Respir Med. 2003 Jan;97(1):20-6
12556006
Am J Respir Crit Care Med. 2000 May;161(5):1608-13
10806163
Respir Med. 2005 Oct;99(10):1325-33
16140232
Value Health. 2006 Jul-Aug;9(4):227-35
16903992
Pharmacoeconomics. 2005;23(4):365-75
15853436
Am J Med. 2006 Oct;119(10 Suppl 1):38-45
16996898
Thorax. 2006 Jan;61(1):29-33
16244087
Can Respir J. 2008 Nov-Dec;15(8):437-43
19107245
Chest. 2004 Jan;125(1):249-59
14718448
JAMA. 2003 Nov 5;290(17):2301-12
14600189
COPD. 2005 Mar;2(1):35-41
17136959
Am J Respir Crit Care Med. 2001 Apr;163(5):1087-92
11316640
Respir Med. 2006 Dec;100(12):2190-6
16635566
Thorax. 2008 Nov;63(11):962-7
18621985
Chest. 2001 Feb;119(2):344-52
11171708
Value Health. 2005 Jan-Feb;8(1):32-46
15841892
Eur Respir J. 2006 Mar;27(3):547-55
16507855
Chest. 2006 Dec;130(6):1704-11
17166985
Eur Respir J. 2004 Feb;23(2):241-9
14979498
Chest. 2006 Jan;129(1):182-7
16424430
Eur Respir J. 2004 May;23(5):692-7
15176681
Curr Med Res Opin. 2006 Aug;22(8):1599-607
16870084
Respir Med. 2002 Aug;96 Suppl C:S23-30
12199488