title: Health Care Utilization and Costs After Initiating Budesonide/Formoterol Combination or Fluticasone/Salmeterol Combination Among COPD Patients New to ICS/LABA Treatment.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) affects approximately 15 million people in the United States and accounts for approximately $36 billion in economic burden, primarily due to medical costs. To address the increasing clinical and economic burden, the Global Initiative for Chronic Obstructive Lung Disease emphasizes the use of therapies that help prevent COPD exacerbations, including inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA).
  
  
  OBJECTIVE
  To evaluate health care costs and utilization among COPD patients newly initiating ICS/LABA combination therapy with budesonide/formoterol (BFC) or fluticasone/salmeterol (FSC) in a managed care system.
  
  
  METHODS
  COPD patients aged 40 years and older who initiated BFC (160/4.5 μg) or FSC (250/50 μg) treatment between March 1, 2009, and March 31, 2012, were identified using claims data from major U.S. health plans. BFC and FSC patients were propensity score matched (1:1) on age, sex, prior asthma diagnosis, prior COPD-related health care utilization, and respiratory medication use. COPD-related, pneumonia-related, and all-cause costs and utilization were analyzed during the 12-month follow-up period. Post-index costs were assessed with generalized linear models (GLMs) with gamma distribution. Health care utilization data were analyzed via logistic regression (any event vs. none) and GLMs with negative binomial distribution (number of visits) and were adjusted for the analogous pre-index variable as well as pre-index characteristics that remained imbalanced after matching.
  
  
  RESULTS
  After matching, each cohort had 3,697 patients balanced on age (mean 64 years), sex (female 52% BFC and 54% FSC), asthma and other comorbid conditions, prior COPD-related health care utilization, and respiratory medication use. During the 12-month follow-up, COPD-related costs averaged $316 less for BFC versus FSC patients ($4,326 vs. $4,846; P = 0.003), reflecting lower inpatient ($966 vs. $1,202; P < 0.001), pharmacy ($1,482 vs. $1,609; P = 0.002), and outpatient/office ($1,378 vs. $1,436; P = 0.048) costs, but higher emergency department ($257 vs. $252; P = 0.033) costs. Pneumonia-related health care costs were also lower on average for BFC patients ($2,855 vs. $3,605; P < 0.001). Similarly, initiating BFC was associated with lower all-use health care costs versus initiating FSC ($21,580 vs. $24,483; P < 0.001, respectively). No differences in health care utilization were found between the 2 groups.
  
  
  CONCLUSIONS
  In this study, although no difference was observed in rates of health care utilization, COPD patients initiating BFC treatment incurred lower average COPD-related, pneumonia-related, and all-cause costs versus FSC initiators, which was driven by cumulative differences in inpatient, outpatient, and pharmacy costs.
authors.affiliation: 1 Director, Health Economics and Outcomes Research, AstraZeneca Pharmaceuticals, Wilmington, Delaware.
authors.forename: Jill R
authors.initials: JR
authors.lastname: Davis
authors.affiliation: 2 Associate Research Director, Industry Sponsored Research, HealthCore, Wilmington, Delaware.
authors.forename: David M
authors.initials: DM
authors.lastname: Kern
authors.affiliation: 3 Senior Director, Medical Evidence Center, AstraZeneca Pharmaceuticals, Gaithersburg, Maryland.
authors.forename: Setareh A
authors.initials: SA
authors.lastname: Williams
authors.affiliation: 4 Director, Industry Sponsored Research, HealthCore, Wilmington, Delaware.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tunceli
authors.affiliation: 5 Research Manager, Industry Sponsored Research, HealthCore, Wilmington, Delaware.
authors.forename: Bingcao
authors.initials: B
authors.lastname: Wu
authors.affiliation: 6 Senior Director and Biometrics Team Leader, AstraZeneca Pharmaceuticals, Alderley Park, Cheshire, United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Hollis
authors.affiliation: 7 Professor, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston.
authors.forename: Charlie
authors.initials: C
authors.lastname: Strange
authors.affiliation: 8 Medical Lead, Respiratory, AstraZeneca Pharmaceuticals, Wilmington, Delaware.
authors.forename: Frank
authors.initials: F
authors.lastname: Trudo
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics; D019819:Budesonide / Q000008:administration & dosage / Q000191:economics*; D004359:Drug Therapy, Combination / Q000191:economics* / Q000379:methods; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination / Q000008:administration & dosage / Q000191:economics*; D000068759:Formoterol Fumarate / Q000008:administration & dosage / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D000068297:Fluticasone-Salmeterol Drug Combination; D019819:Budesonide; D000068759:Formoterol Fumarate