Abstract:Background:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common in patients with underlying moderate to severe COPD and are associated with increased health and economic burden. International and Chinese guidelines recommend using glucocorticoids for the management of AECOPD because glucocorticoid therapy has been shown to benefit clinical outcomes. However, only scant data are available for current status of glucocorticoid therapy in hospitalized AECOPD patients in China. The aim o… Show more
“…As monotherapy treatment was the most commonly prescribed regimen in the primary study,24 we also analyzed the total medical expenditure for patients who received either nBUD or SCS alone in our analysis. Treatment with nBUD alone also resulted in significantly lower total medical expenditure of 8.7% compared with SCS alone ( P =0.0013).…”
Section: Discussionmentioning
confidence: 99%
“…Overall, 5,067 patients with AECOPD admitted to hospitals between January and September 2014 were enrolled in the primary study and were eligible for this post-hoc analysis (Figure 1). Full details on the study design and methodology have been described previously;24 data underlying the findings described in this article may be obtained in accordance with AstraZeneca’s data sharing policy, described at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.Figure 1Study design. Any nBUD regimen is defined as nBUD monotherapy, sequential therapy (ie, initiated with nBUD at hospitalization and later switched to SCS), and sequential-combination therapy (initiated with nBUD at hospitalization and later combined with SCS).…”
Purpose:
Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population.
Patients and methods:
A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received “any” nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission.
Results:
The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen (
P
=0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure (
P
<0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS (
P
=0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen (
P
=0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%;
P
=0.2299).
Conclusion:
AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.
“…As monotherapy treatment was the most commonly prescribed regimen in the primary study,24 we also analyzed the total medical expenditure for patients who received either nBUD or SCS alone in our analysis. Treatment with nBUD alone also resulted in significantly lower total medical expenditure of 8.7% compared with SCS alone ( P =0.0013).…”
Section: Discussionmentioning
confidence: 99%
“…Overall, 5,067 patients with AECOPD admitted to hospitals between January and September 2014 were enrolled in the primary study and were eligible for this post-hoc analysis (Figure 1). Full details on the study design and methodology have been described previously;24 data underlying the findings described in this article may be obtained in accordance with AstraZeneca’s data sharing policy, described at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.Figure 1Study design. Any nBUD regimen is defined as nBUD monotherapy, sequential therapy (ie, initiated with nBUD at hospitalization and later switched to SCS), and sequential-combination therapy (initiated with nBUD at hospitalization and later combined with SCS).…”
Purpose:
Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population.
Patients and methods:
A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received “any” nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission.
Results:
The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen (
P
=0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure (
P
<0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS (
P
=0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen (
P
=0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%;
P
=0.2299).
Conclusion:
AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.
“…In fact, two studies suggested that the use of SCS, particularly at high doses and with long duration, in patients with AECOPD and respiratory failure, will not help the patients survive their AECOPD event. 25,26 A previous study in China showed that the most common daily dose of methylprednisolone injection was 40 mg, followed by 80 mg and 20 mg, while the most common daily dose of oral methylprednisolone was 20 mg, followed by 16 mg and 8 mg; in comparison, the most common daily dose of nebulized budesonide was 2 mg, followed by 4 mg and 6 mg. 15 In this previous study, the mean length of hospitalization was 12.2±6.2 days and the mortality rate during hospitalization was 1.2%. 15 In the present study, the dose of corticosteroids was of course lower in the NCS group compared with the two other groups, but the duration of treatment was similar.…”
Section: Discussionmentioning
confidence: 78%
“…The primary objective was to investigate the treatment patterns of AECOPD in hospitalized patients in China. 15 The outcomes of the original study were the percentage of patients receiving glucocorticoids by different routes of administration, doses and duration, mortality, and the mean length of hospitalization. 15 Forty sites (93.0%) were tertiary hospitals located in major cities.…”
Section: Methodsmentioning
confidence: 99%
“…15 The outcomes of the original study were the percentage of patients receiving glucocorticoids by different routes of administration, doses and duration, mortality, and the mean length of hospitalization. 15 Forty sites (93.0%) were tertiary hospitals located in major cities. The original study and post hoc analyses were approved by the local ethics committees (Appendix 1) and conducted in accordance with the Declaration of Helsinki.…”
Background and Objective: Although corticosteroids have been widely used in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), few studies have evaluated the effectiveness of nebulized corticosteroids (NCS), systemic corticosteroids (SCS), and NCS plus SCS in the management of AECOPD in China. This study aimed to evaluate the effectiveness of NCS, SCS, and NCS plus SCS in Chinese patients with AECOPD. Patients and Methods: This was a real-world study of AECOPD patients at 43 sites from January to September 2014. During hospitalization, patients treated with nebulized budesonide (NCS group, n=1091), SCS (SCS group, n=709), or both (NCS+SCS group, n=1846) were included. Propensity score matching (PSM) and subgroup analyses were performed. The primary outcomes were the length of hospital stay, mortality, and change in arterial blood gases from baseline. Results: Multivariable analysis showed that the three treatments at the same severity of AECOPD were not significantly different regarding intubation rates, rates of pneumonia improvement at discharge, rates of new-onset pneumonia in hospital, and mortality. Following PSM, NCS+SCS was associated with greater length of hospital stay than both NCS and SCS (in patients without respiratory failure [RF, P<0.001] and with type I RF [P=0.022]), and more hospitalization costs than the other two treatments (in patients without RF [P<0.001]). Conclusion: NCS is effective for patients with AECOPD, which may be an alternative treatment option. Further clinical trials are urgently needed to better understand the efficacy of NCS, SCS, and NCS+SCS in AECOPD management in China.
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