title: Rehospitalization risks and outcomes in COPD patients receiving maintenance pharmacotherapy.
abstract: OBJECTIVE
  To determine clinical and economic outcomes following COPD-related hospitalization/emergency department (ED) care in patients receiving COPD maintenance therapy.
  
  
  METHODS
  In this retrospective, observational study using administrative claims data, we identified COPD patients age ≥40 years who received maintenance therapy within 30 days of an initial COPD-related hospitalization or ED visit with: (1) fluticasone propionate/salmeterol combination (FSC 250 mcg/50 mcg) as new therapy, or (2) an anticholinergic (AC; tiotropium or ipratropium with or without albuterol). The FSC and AC patients were matched (1:3 ratio) on various baseline characteristics using propensity scores to mitigate selection bias at baseline. The proportion of patients with COPD-related healthcare events, the mean event rates, and the mean costs in the subsequent 12 months were calculated.
  
  
  RESULTS
  The FSC cohort (N = 484) had a significantly lower proportion of rehospitalized patients during follow-up than did the AC cohort (N = 1452), 3.1% versus 4.6% (P = 0.047). The mean number of rehospitalizations was 0.03 in the FSC cohort and 0.07 in the AC cohort (P = 0.001). The proportion of patients with an exacerbation resulting in an ED or physician-outpatient visit and the mean number of such visits did not differ between cohorts. Total annual COPD-related medical costs were lower for FSC than for AC ($2080 versus $2636, P = 0.006), with lower medical and higher pharmacy costs.
  
  
  CONCLUSIONS
  Patients receiving FSC as maintenance therapy following an initial COPD-related hospitalization or ED visit experienced better clinical and economic outcomes than patients receiving AC.
authors.affiliation: GlaxoSmithKline, 5 Moore Dr., Bide West, Mail Stop B.3153, Research Triangle Park, NC 27709, USA. anand.a.dalal@gsk.com
authors.forename: Anand A
authors.initials: AA
authors.lastname: Dalal
authors.forename: Manan
authors.initials: M
authors.lastname: Shah
authors.forename: Anna O
authors.initials: AO
authors.lastname: D'Souza
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Crater
mesh_terms: D000328:Adult; D000368:Aged; D000420:Albuterol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000191:economics / Q000627:therapeutic use; D004338:Drug Combinations; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination; D005938:Glucocorticoids / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D009241:Ipratropium / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012602:Scopolamine Derivatives / Q000191:economics / Q000627:therapeutic use; D000069447:Tiotropium Bromide; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D005938:Glucocorticoids; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000420:Albuterol; D000069447:Tiotropium Bromide