title: Comparative health-care cost advantage of ipratropium over tiotropium in COPD patients.
abstract: OBJECTIVE
  To compare the total direct health-care costs of patients treated with tiotropium and ipratropium.
  
  
  METHODS
  We conducted a cohort study of health-care costs in British Columbia, Canada, by comparing new patients on tiotropium with new patients on ipratropium. Direct health-care costs for study patients were measured in the first 2 years after initiating inhaled anticholinergic treatment. Differences in direct health-care costs between tiotropium and ipratropium patients were estimated by using quantile regression. We analyzed cost differences in the 10th percentile, median, and 90th percentile of patients by cost. High-dimensional propensity score analysis was used as a method of adjustment for potential confounding factors.
  
  
  RESULTS
  The study population had 3,140 tiotropium patients and 26,182 ipratropium patients. Higher health system costs in patients who started on tiotropium instead of ipratropium were observed in patients in the median and 10th percentile. The magnitude of these increases was comparable to the price difference between the two drugs. Health system costs in the 90th percentile were not significantly different between tiotropium and ipratropium patients.
  
  
  CONCLUSIONS
  The results of this study did not support the preferential use of tiotropium over ipratropium as a basis for savings in direct health-care costs.
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada. colin.dormuth@ti.ubc.ca
authors.forename: Colin R
authors.initials: CR
authors.lastname: Dormuth
authors.forename: Jesse
authors.initials: J
authors.lastname: Yamaguchi
authors.forename: Brett
authors.initials: B
authors.lastname: Wilmer
authors.forename: David
authors.initials: D
authors.lastname: Hosick
authors.forename: Til
authors.initials: T
authors.lastname: Stürmer
authors.forename: Greg
authors.initials: G
authors.lastname: Carney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D009241:Ipratropium / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012602:Scopolamine Derivatives / Q000191:economics* / Q000627:therapeutic use; D000069447:Tiotropium Bromide
chemical_list: D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000069447:Tiotropium Bromide