Exacerbations, health services utilization, and costs in commercially-insured COPD patients treated with nebulized long-acting β2-agonists

Chen, Yaozhu J.; Makin, Charles; Bollu, Vamsi; Navaie, Maryam; Celli, Bartolomé R.

doi:10.3111/13696998.2015.1079530

Cited by 6 publications

(6 citation statements)

References 44 publications

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“…In addition, a recent retrospective cohort study using commercial health care insurance claims reported lower hospitalization costs for arformoterol-treated patients with COPD who were hospitalized compared to formoterol patients who were hospitalized 15. Assuming that a shorter LOS corresponds with lower hospital costs, these findings are consistent with the current study.…”

Section: Discussionsupporting

confidence: 90%

“…Based on clinical evidence, initiation of maintenance treatment with long-acting bronchodilators is recommended for hospitalized patients after stabilization and prior to discharge from the hospital 3. Not surprisingly, treatment with long-acting bronchodilators in the outpatient setting has been found to reduce future hospital admissions 15. When patients with COPD are effectively treated, their symptoms can be minimized and disease progression can be slowed 16…”

Section: Introductionmentioning

confidence: 99%

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Health resource utilization for inpatients with COPD treated with nebulized arformoterol or nebulized formoterol

Ganapathy

Stensland²

2017

COPD

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ObjectiveArformoterol is the (R,R)-enantiomer of formoterol. Preclinical studies suggest that it is a stronger bronchodilator than the racemic (R,R/S,S)-formoterol; however, its potential clinical advantages have not been demonstrated. This study compared the length of stay (LOS), 30-day readmission rates, and doses of rescue medication administered in hospitalized patients with COPD who were treated with nebulized arformoterol or nebulized formoterol.MethodsThis retrospective analysis utilized data from Premier, Inc. (Charlotte, NC, USA), the largest nationwide hospital-based administrative database. COPD patients ≥40 years of age were included if they were hospitalized between January 2011 and July 2014, had no asthma diagnoses, and were treated with nebulized arformoterol or nebulized formoterol. LOS was measured from the day the patients initiated the study medication (index day). Rescue medications were defined as short-acting bronchodilators used from the index day onward. Multivariate statistical models included a random effect for hospital and controlled for patient demographics, hospital characteristics, admission characteristics, prior hospitalizations, comorbidities, pre-index service use, and pre-index medication use.ResultsA total of 7,876 patients received arformoterol, and 3,612 patients received nebulized formoterol. There was no significant difference in 30-day all-cause (arformoterol =11.9%, formoterol =12.1%, odds ratio [OR] =0.981, P=0.82) or COPD-related hospital readmission rates (arformoterol =8.0%, formoterol =8.0%, OR =1.002, P=0.98) after adjusting for covariates. The adjusted mean LOS was significantly shorter for arformoterol-treated vs formoterol-treated patients (4.6 vs 4.9 days, P=0.039), and arformoterol-treated patients used significantly fewer doses of rescue medications vs formoterol-treated patients (5.9 vs 6.6 doses, P=0.006).ConclusionDuring inpatient stays, treating with arformoterol instead of nebulized formoterol may lead to shorter LOS and lower rescue medication use.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Health resource utilization for inpatients with COPD treated with nebulized arformoterol or nebulized formoterol

Ganapathy

Stensland²

2017

COPD

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“…29 In a 2016 retrospective study of 417 COPD patients using nebulized LABA therapy, PharMetrics Plus health plan claims data were used to compare exacerbations, health services utilization, and costs. 30 In this study, use of nebulized arformoterol was associated with fewer exacerbations, lower inpatient costs, lower risk for exacerbations, and lower COPDrelated costs (primarily related to hospital readmissions) than in patients using nebulized formoterol, suggesting that medication choice even within the same class may affect outcomes and costs. 30 The authors acknowledged that the prevention of hospitalizations cannot be accomplished with prescribed agents alone, and a comprehensive COPD action plan is needed to help patients stay out of the hospital to the extent possible.…”

Section: Hospitalizations From Exacerbations Of Copdmentioning

confidence: 58%

Chronic Obstructive Pulmonary Disease in Post-acute/Long-term Care Settings: Seizing Opportunities to Individualize Treatment and Device Selection

Patel

Steinberg

Suarez-Barcelo

et al. 2017

Journal of the American Medical Directors Association

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“…In another 52-week trial, neb arformoterol treated patients were found to have greater improvements in health status and health-related quality-of-life than patients who received placebo 53,54. Research comparing nebulized LABA therapies has shown that patients treated with arformoterol have fewer exacerbations, lower inpatient costs, and lower COPD-related costs (primarily related to hospitalizations) when compared with patients treated with formoterol 55,56. In Medicare populations, LABA therapy has been shown to significantly lower the risk of hospitalizations, resulting in fewer inpatient days and lower total health care utilization when compared with SABA therapy 57–59.…”

Section: Discussionmentioning

confidence: 99%

Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment

Celli¹,

Navaie²,

Xu³

et al. 2019

COPD

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Purpose: Global evidence-based treatment strategies for chronic obstructive pulmonary disease (COPD) recommend using long-acting bronchodilators (LABDs) as maintenance therapy. However, COPD patients are often undertreated. We examined COPD treatment patterns among Medicare beneficiaries who initiated arformoterol tartrate, a nebulized long-acting beta 2 agonist (LABA), and identified the predictors of initiation. Methods: Using a 100% sample of Medicare administrative data, we identified beneficiaries with a COPD diagnosis (ICD-9 490–492.xx, 494.xx, 496.xx) between 2010 and 2014 who had ≥1 year of continuous enrollment in Parts A, B, and D, and ≥2 COPD-related outpatient visits within 30 days or ≥1 hospitalization(s). After applying inclusion/exclusion criteria, three cohorts were identified: (1) study group beneficiaries who received nebulized arformoterol (n=11,886), (2) a subset of the study group with no LABD use 90 days prior to initiating arformoterol (n=5,542), and (3) control group beneficiaries with no nebulized LABA use (n=220,429). Logistic regression was used to evaluate predictors of arformoterol initiation. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were computed. Results: Among arformoterol users, 47% (n=5,542) had received no LABDs 90 days prior to initiating arformoterol. These beneficiaries were being treated with a nebulized (50%) or inhaled (37%) short-acting bronchodilator or a systemic corticosteroid (46%), and many received antibiotics (37%). Compared to controls, beneficiaries who initiated arformoterol were significantly more likely to have had an exacerbation, a COPD-related hospitalization, and a pulmonologist or respiratory therapist visit prior to initiation (all p <0.05). Beneficiaries with moderate/severe psychiatric comorbidity or dual-eligible status were significantly less likely to initiate arformoterol, as compared to controls (all p <0.05). Conclusion: Medicare beneficiaries who initiated nebulized arformoterol therapy had more exacerbations and hospitalizations than controls 90 days prior to initiation. Findings revealed inadequate use of maintenance medications, suggesting a lack of compliance with evidence-based treatment guidelines.

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Exacerbations, health services utilization, and costs in commercially-insured COPD patients treated with nebulized long-acting β2-agonists

Abstract: This study suggests that the choice of nebulized LABA may influence COPD-related exacerbation occurrence and costs. Future studies with larger and more closely matched nebulized arformoterol and nebulized formoterol users are needed to confirm these findings.

Cited by 6 publications

References 44 publications

Health resource utilization for inpatients with COPD treated with nebulized arformoterol or nebulized formoterol

Health resource utilization for inpatients with COPD treated with nebulized arformoterol or nebulized formoterol

Chronic Obstructive Pulmonary Disease in Post-acute/Long-term Care Settings: Seizing Opportunities to Individualize Treatment and Device Selection

<p>Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment</p>

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