Readmission Risk in Chronic Obstructive Pulmonary Disease Patients: Comparative Study of Nebulized β2-Agonists

Abstract

BackgroundBronchodilators are used for managing the symptoms of chronic obstructive pulmonary disease (COPD) and minimizing the risk of hospitalization and readmission. Hospital readmission is predictive of morbidity and mortality.ObjectiveThe study objective was to compare all-cause readmission risk in COPD patients receiving nebulized long-acting β2-agonists (neb-LABAs) versus nebulized short-acting β2-agonists (neb-SABA) following COPD-related hospitalization discharge.MethodsThis retrospective analysis utilized US-based pharmacy and medical claims records (2001–2011) to identify COPD patients aged ≥40 years receiving neb-LABA or neb-SABA treatment within 30 days following discharge from a COPD-related hospitalization. Patients had to be continuously enrolled in their health plan for ≥6 months before and after their first neb-LABA or neb-SABA prescription fill (index date), and adherent to the treatment for the first 3 months post-index date. To select patients with similar severity profiles, neb-LABA and neb-SABA patients were matched by baseline characteristics. Readmission risks were observed over the 6-month period following the index date and compared between neb-LABA and neb-SABA cohorts using the multiple variable Cox proportional hazards model.ResultsThe analysis included 246 matched patients (neb-LABA = 123; neb-SABA = 123). The mean age was 67 years, and 54% were female. The average length of stay during index hospitalization was 4.4 days. After adjusting for potential confounders, the risk of readmission was 47% lower in the neb-LABA cohort than in the neb-SABA cohort (hazard ratio 0.53, 95% confidence interval 0.30–0.96; P = 0.0349).ConclusionsPatients receiving neb-LABAs had a significantly lower readmission risk within 6 months following a COPD-related hospitalization versus patients treated with neb-SABAs.

Reduction in Hospital Readmission Rates Among Medicare Beneficiaries With Chronic Obstructive Pulmonary Disease: A Real-world Outcomes Study of Nebulized Bronchodilators

“…26 A second study found that the adjusted risk of all-cause readmission at 6 months was 47% lower in patients with COPD who received a nebulized LABA (ie, ARF or formoterol) compared with patients treated with a nebulized SABA for maintenance therapy after having been discharged for a COPD-related hospitalization. 27 The 30-day exacerbation rates were found to be comparable between nebulized ARF users and nebulized SABA users. There are several implications of this finding.…”

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

“…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. Research specific to medication adherence has found significantly lower risk of hospitalizations and decreased health care costs among Medicare beneficiaries who adhere to COPD maintenance medication regimens as compared to beneficiaries who discontinue maintenance therapy 36,60,61.…”