title: Outcomes and costs associated with initial maintenance therapy with fluticasone propionate-salmeterol xinafoate 250 microg/50 microg combination versus tiotropium in commercially insured patients with COPD.
abstract: OBJECTIVE
  To compare, in commercially-insured individuals 240 years old, the risk of chronic obstructive pulmonary disease (COPD) exacerbations and COPD-related health care utilization and costs in patients initiating maintenance treatment with fluticasone propionate/salmeterol xinafoate 250 microg/50 microg (FSC) with those in patients initiating treatment with tiotropium bromide (TIO).
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  The risk of COPD exacerbation (moderate, severe, and any), COPD-related health care utilization, and COPD-related costs (overall and by service setting) were assessed over 12 months after the initiation of treatment with FSC or TIO in commercially-insured patients > or =40 years old diagnosed with COPD.
  
  
  RESULTS
  After adjusting for covariates, treatment with FSC compared with treatment with TIO was associated with a 14% reduction in risk of severe exacerbation (p = 0.0406), defined as the occurrence of a COPD-related hospitalization; with less health care utilization across several categories of care; with 25% lower COPD-related medical costs ($1814 versus $2258 per patient, p < 0.0001); and with 10% lower COPD-related total costs ($2991 versus $3304 per patient, p < 0.0001) over a 12-month follow-up period. Pharmacy costs were equivalent between FSC and TIO.
  
  
  CONCLUSIONS
  Initiation of maintenance therapy with FSC compared with TIO was associated with significant reductions in the risk of severe exacerbations, health care utilization, and COPD-related medical and total costs. Considered in the context of other findings, these data suggest that earlier maintenance treatment with FSC offers clinical and economic benefits over maintenance treatment with TIO.
authors: U.S. Health Outcomes, GlaxoSmithKline, Research Triangle Park, 5 Moore Drive, Mail Stop B.3153, Durham, NC 27709, USA. anand.a.dalal@gsk.com
authors: Anand A
authors: AA
authors: Dalal
authors: Sean D
authors: SD
authors: Candrilli
authors: Keith L
authors: KL
authors: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000730:Androstadienes / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D004338:Drug Combinations; D016527:Drug Costs; D004359:Drug Therapy, Combination; D017850:Economics, Pharmaceutical; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination; D005938:Glucocorticoids / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D005938:Glucocorticoids; D012602:Scopolamine Derivatives; D000420:Albuterol; D000069447:Tiotropium Bromide