title: Albuterol and levalbuterol use and spending in Medicare beneficiaries with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The evidence for the benefits of branded levalbuterol over generic albuterol in patients with chronic obstructive pulmonary disease (COPD) is inconclusive. However, there are significant cost differences between these products.
  
  
  OBJECTIVE
  This study examined use and spending on albuterol and levalbuterol in a nationally representative sample of Medicare beneficiaries with COPD enrolled in Part D in 2006. It also examined differences in patient characteristics and use of other COPD drugs among recipients of these 2 short-acting β-agonists.
  
  
  METHODS
  Data were obtained from the 5% Medicare files for 2005-2006 linked to the 2006 Medicare Part D files. The sample consisted of all fee-for-service beneficiaries with COPD enrolled in stand-alone Part D plans in 2006. Patient characteristics and other COPD medication use were compared across albuterol-only users, levalbuterol-only users, and users of both albuterol and levalbuterol. Multinomial logistic regressions were used to identify factors independently associated with levalbuterol use.
  
  
  RESULTS
  There were 5.5 times more albuterol users than levalbuterol users in 2006; however, mean annual spending on levalbuterol was 18.6 times higher per user in 2006 than spending on albuterol ($1876 vs $101 per user, respectively). Levalbuterol-only users were more likely to be older than albuterol-only users (mean age: 71.5 vs 68.7 years; P < 0.05), as well as sicker (mean prescription drug hierarchical condition category score: 1.72 vs 1.55; P < 0.05) and residing in the South (67.9% vs 41.6%; P < 0.05). Levalbuterol-only users were more likely to use nebulizer forms covered under Part B than inhaler forms covered under Part D (78.6% vs 26.8%, respectively; P < 0.05), whereas albuterol-only users were more likely to use inhaler forms covered under Part D than nebulizer forms covered under Part B (82.2% vs 33.0%, respectively; P < 0.05).
  
  
  CONCLUSIONS
  In this sample of Medicare beneficiaries with COPD enrolled in Part D, mean annual spending in 2006 was significantly higher for levalbuterol than for albuterol. The differences between levalbuterol and albuterol users in terms of patient characteristics, geographic region, and drug formulation/device type, coupled with the inconclusive evidence for efficacy differences in the literature, highlight the need for further comparative clinical and cost-effectiveness studies of these agents.
authors.affiliation: Department of Health Care Management and Economics, Wharton School, University of Pennsylvania, Philadelphia, 19104–6021, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Puig
authors.forename: Sean
authors.initials: S
authors.lastname: McElligott
authors.forename: Henry
authors.initials: H
authors.lastname: Bergquist
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics; D013237:Stereoisomerism; D014481:United States
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D000420:Albuterol