title: Clinical and economic outcomes of multiple versus single long-acting inhalers in COPD.
abstract: OBJECTIVE
  To compare healthcare resource utilization and healthcare costs between COPD patients who used multiple long-acting inhalers versus those who used a single long-acting inhaler.
  
  
  METHODS
  COPD patients meeting study inclusion criteria were identified in the Market Scan database (2004-2008) and were classified as being a multiple- or single-inhaler user. 11,747 multiple- and single-inhaler users were matched on baseline characteristics to balance disease severity. Patients were followed for 12 months. Incremental differences between the two groups were estimated for: number of exacerbations; time to first exacerbation; all-cause and COPD-related inpatient admissions, inpatient days, emergency room visits, urgent care visits, outpatient visits, and other medical services visits; all-cause and COPD-related healthcare costs. Multivariate regression analyses were also used to control for a number of potentially confounding factors.
  
  
  RESULTS
  After controlling for a number of potentially confounding factors, multiple-inhaler users experienced significantly more exacerbations (0.52; p < .0001) and had a higher risk of exacerbation (HR = 1.40; p < .0001) than single-inhaler users. Multiple-inhaler users also incurred significantly more inpatient admissions (IRR = 1.15; p < .0001), inpatient days (IRR = 1.20; p < .0001), urgent care visits (IRR = 1.10; p = 0.0026), outpatient visits (IRR = 1.06; p < .0001), and other medical services visits (IRR = 1.12; p = <.001) than single-inhaler users, resulting in significantly higher all-cause health care costs ($3,319; p < .0001). Results of COPD-related resource use and costs were comparable.
  
  
  CONCLUSIONS
  After controlling for a number of potentially confounding factors, multiple-inhaler users had more exacerbations, a higher risk of exacerbation, and higher healthcare resource utilization and costs compared to single-inhaler users.
authors.affiliation: Analysis Group Inc., 111 Huntington Avenue, Boston, MA 02199, USA. ayu@analysisgroup.com
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Yu
authors.forename: Annie
authors.initials: A
authors.lastname: Guérin
authors.forename: Diego Ponce
authors.initials: DP
authors.lastname: de Leon
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramakrishnan
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Michelle
authors.initials: M
authors.lastname: Mocarski
authors.forename: Steven I
authors.initials: SI
authors.lastname: Blum
authors.forename: Juliana
authors.initials: J
authors.lastname: Setyawan
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics*; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D001993:Bronchodilator Agents