Comparative Effectiveness Research and Cost-Consequence Analysis of Albuterol and Levalbuterol in Patients with Chronic Obstructive Pulmonary Disease.

摘要

Objectives: To describe the health services utilization and prescription drugs use in South Carolina Medicaid enrollees with Chronic Obstructive Pulmonary Disease (COPD); to determine the comparative effectiveness of levalbuterol vs. albuterol in terms of healthcare resources utilization (primarily COPD-related hospitalizations and emergency department visits); and to estimate the value for money of levalbuterol for COPD, which is a new treatment comparing to albuterol, using cost-consequence approach.;Methods: A retrospective, observational, cohort (longitudinal) study of COPD patients in South Carolina Medicaid programs. The study identified patients with COPD and those who used albuterol and/or levalbuterol from 1999 to 2010. Descriptive statistics was used for health services and drugs use as well as patient profiles. Propensity score matching was used to control for selection bias in albuterol and levalbuterol users. Negative binomial regression was then employed to compare the number of healthcare resources utilization while offset follow-up period. A cost-consequence analysis was also conducted to compare the economic impact of initial use of levalbuterol and racemic albuterol on the subsequent healthcare costs. Cost data were adjusted to 2010 US;Results: In total, 90,217 COPD patients were identified, and ∼50% had ever at least one prescription claim for either albuterol or levalbuterol. Using propensity score matching, 343 pairs of COPD patients taking albuterol and levalbuterol were identified. There was no difference in health services utilization between these two groups. The conclusion is robust across most of the primary and secondary outcome measures and sensitivity analyses, except that levalbuterol users had 34% more COPD-related all healthcare resource utilization than albuterol users when regression model was done in all eligible patients rather than PS matched patients. The cost-consequence analysis showed that there was no difference in all-cause total healthcare costs between levalbuterol and racemic albuterol; however, the SC Medicaid programs paid for racemic albuterol users US;Conclusions: Patients initially prescribed levalbuterol seemed to have no difference in all-cause health service utilization and healthcare cost in the following one year comparing with racemic albuterol, and there was significant difference in COPD-related health service use and costs. This suggests that racemic albuterol might be equally or similarly effective initial therapy for patients with COPD comparing with levalbuterol in the first year of their use. Future research is needed to examine the longer-term comparative effectiveness (e.g., using mortality as outcome measure) and economic impact.