title: A new method for examining the cost savings of reducing COPD exacerbations.
abstract: 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.
authors.affiliation: Lovelace Clinic Foundation, Albuquerque, New Mexico 87106-4264, USA. Doug.Mapel@LCFresearch.org
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Mapel
authors.forename: Michael
authors.initials: M
authors.lastname: Schum
authors.forename: Eva
authors.initials: E
authors.lastname: Lydick
authors.forename: Jeno P
authors.initials: JP
authors.lastname: Marton
mesh_terms: 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
chemical_list: D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D009241:Ipratropium; D000420:Albuterol
references.citation: Clin Ther. 2003 Jan;25(1):285-97
references.pmid: 12637127
references.citation: Eur Respir J. 2002 Feb;19(2):217-24
references.pmid: 11866001
references.citation: Lancet. 2003 Feb 8;361(9356):449-56
references.pmid: 12583942
references.citation: Respir Med. 2007 Nov;101(11):2312-20
references.pmid: 17681461
references.citation: Respir Med. 2004 Feb;98(2):99-107
references.pmid: 14971871
references.citation: Ann Intern Med. 2007 Apr 17;146(8):545-55
references.pmid: 17310045
references.citation: Eur J Health Econ. 2007 Jun;8(2):123-35
references.pmid: 17370096
references.citation: Value Health. 2004 Mar-Apr;7(2):153-67
references.pmid: 15164805
references.citation: Respir Med. 2008 Mar;102(3):413-21
references.pmid: 18086519
references.citation: Respir Med. 2008 Aug;102(8):1099-108
references.pmid: 18614347
references.citation: Ann Intern Med. 2005 Sep 6;143(5):317-26
references.pmid: 16144890
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: Eur Respir J. 2002 Feb;19(2):209-16
references.pmid: 11871363
references.citation: Lancet. 1998 Mar 14;351(9105):773-80
references.pmid: 9519948
references.citation: Thorax. 2003 May;58(5):399-404
references.pmid: 12728159
references.citation: Can Respir J. 2007 Apr;14(3):145-52
references.pmid: 17464378
references.citation: Respir Med. 2003 Mar;97(3):212-20
references.pmid: 12645827
references.citation: Arch Intern Med. 2000 Sep 25;160(17):2653-8
references.pmid: 10999980
references.citation: Value Health. 2008 Jul-Aug;11(4):628-36
references.pmid: 18194402
references.citation: Am J Respir Crit Care Med. 2007 Jan 15;175(2):144-9
references.pmid: 17053207
references.citation: Respir Med. 2009 Mar;103(3):373-8
references.pmid: 19013781
references.citation: Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55
references.pmid: 17507545
references.citation: Pharmacoeconomics. 2005;23(6):619-37
references.pmid: 15960557
references.citation: Respir Med. 2004 Sep;98(9):883-91
references.pmid: 15338802
references.citation: Respir Med. 2009 Jan;103(1):12-21
references.pmid: 19010652
references.citation: Thorax. 2006 Feb;61(2):122-8
references.pmid: 16443706
references.citation: Lancet. 1999 May 29;353(9167):1819-23
references.pmid: 10359405
references.citation: Respir Med. 2002 Sep;96(9):700-8
references.pmid: 12243316
references.citation: Eur Respir J. 2004 Jun;23(6):932-46
references.pmid: 15219010
references.citation: Health Serv Res. 2008 Dec;43(6):2164-82
references.pmid: 18671750
references.citation: Eur Respir J. 2003 Dec;22(6):912-9
references.pmid: 14680078
references.citation: Can Respir J. 2002 May-Jun;9(3):178-85
references.pmid: 12068339
references.citation: Chest. 2000 May;117(5 Suppl 2):398S-401S
references.pmid: 10843984
references.citation: Am J Manag Care. 2008 Jul;14(7):438-48
references.pmid: 18611095
references.citation: N Engl J Med. 2005 Oct 6;353(14):1516-22
references.pmid: 16207857
references.citation: Chest. 1999 Apr;115(4):957-65
references.pmid: 10208192
references.citation: Ann Intern Med. 2008 Jun 17;148(12):956-61
references.pmid: 18483128
references.citation: Chest. 2007 Jan;131(1):20-8
references.pmid: 17218552
references.citation: Pharmacoeconomics. 2004;22(11):741-9
references.pmid: 15250751
references.citation: BMJ. 2000 May 13;320(7245):1297-303
references.pmid: 10807619
references.citation: Chest. 2006 Jun;129(6):1693-708
references.pmid: 16778291
references.citation: Respir Med. 2003 Jan;97(1):20-6
references.pmid: 12556006
references.citation: Am J Respir Crit Care Med. 2000 May;161(5):1608-13
references.pmid: 10806163
references.citation: Respir Med. 2005 Oct;99(10):1325-33
references.pmid: 16140232
references.citation: Value Health. 2006 Jul-Aug;9(4):227-35
references.pmid: 16903992
references.citation: Pharmacoeconomics. 2005;23(4):365-75
references.pmid: 15853436
references.citation: Am J Med. 2006 Oct;119(10 Suppl 1):38-45
references.pmid: 16996898
references.citation: Thorax. 2006 Jan;61(1):29-33
references.pmid: 16244087
references.citation: Can Respir J. 2008 Nov-Dec;15(8):437-43
references.pmid: 19107245
references.citation: Chest. 2004 Jan;125(1):249-59
references.pmid: 14718448
references.citation: JAMA. 2003 Nov 5;290(17):2301-12
references.pmid: 14600189
references.citation: COPD. 2005 Mar;2(1):35-41
references.pmid: 17136959
references.citation: Am J Respir Crit Care Med. 2001 Apr;163(5):1087-92
references.pmid: 11316640
references.citation: Respir Med. 2006 Dec;100(12):2190-6
references.pmid: 16635566
references.citation: Thorax. 2008 Nov;63(11):962-7
references.pmid: 18621985
references.citation: Chest. 2001 Feb;119(2):344-52
references.pmid: 11171708
references.citation: Value Health. 2005 Jan-Feb;8(1):32-46
references.pmid: 15841892
references.citation: Eur Respir J. 2006 Mar;27(3):547-55
references.pmid: 16507855
references.citation: Chest. 2006 Dec;130(6):1704-11
references.pmid: 17166985
references.citation: Eur Respir J. 2004 Feb;23(2):241-9
references.pmid: 14979498
references.citation: Chest. 2006 Jan;129(1):182-7
references.pmid: 16424430
references.citation: Eur Respir J. 2004 May;23(5):692-7
references.pmid: 15176681
references.citation: Curr Med Res Opin. 2006 Aug;22(8):1599-607
references.pmid: 16870084
references.citation: Respir Med. 2002 Aug;96 Suppl C:S23-30
references.pmid: 12199488