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Milewska A, Rysiak E, Zareba I, Holownia A, Mroz RM. Costs of Treatment of Chronic Obstructive Pulmonary Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 885:67-75. [PMID: 26801145 DOI: 10.1007/5584_2015_199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The aim of this study was to analyze direct costs of COPD therapy in relation with clinical course and stage of the disease. Sixty patients with moderate to severe COPD were included into the study. The average cost was taken from institutional data file and was also assessed from a social perspective. Results were presented as average costs per patient per year. Forty two percent of patients was classified as GOLD D category, while categories A, B, and C accounted for 8 %, 27 %, and 23 %, respectively. Approximately 65 % of patients had 2-3 degrees of dyspnea according to the Modified Medical Research Council Dyspnea Scale. About 60 % of patients underwent two or three exacerbations per year and those patients had one or two co-morbidities diagnosed. Treatment costs almost doubled with disease progression, mainly due to exacerbations. In patients in Group C and Group D with exacerbations the direct costs were several times higher than in group A or B and the difference increased with progression of the disease. In Groups A and B, the costs of treatment of stable disease or with exacerbation were comparable. We conclude that costs of treatment of COPD patients were highest in advanced disease and were strongly related to COPD exacerbations.
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Affiliation(s)
- A Milewska
- Respiratory Medicine Center, 9a Piasta St., 15-044, Bialystok, Poland
| | - E Rysiak
- Department of Medicinal Chemistry, Bialystok Medical University, 2d Mickiewicza St., 15-222, Bialystok, Poland
| | - I Zareba
- Department of Medicinal Chemistry, Bialystok Medical University, 2d Mickiewicza St., 15-222, Bialystok, Poland
| | - A Holownia
- Department of Clinical Pharmacology, Bialystok Medical University, 15a Waszyngtona St., Bialystok, Poland
| | - R M Mroz
- Respiratory Medicine Center, 9a Piasta St., 15-044, Bialystok, Poland. .,Department of Lung Diseases and Tuberculosis, Bialystok Medical University, 14 Zurawia St., 15-540, Bialystok, Poland.
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Adherence to Oral Therapy for Urgency Urinary Incontinence: Results from the Anticholinergic Versus Botox Comparison (ABC) Trial. Female Pelvic Med Reconstr Surg 2015; 22:24-8. [PMID: 26516810 DOI: 10.1097/spv.0000000000000215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Medication adherence with urgency urinary incontinence (UUI) treatment is challenging and the best assessment methodology is uncertain. We sought to describe adherence with anticholinergic (AC) versus placebo (P) by comparing pill counts and MEMSCAP event data and to identify factors associated with adherence. METHODS The randomized controlled AC versus Botox Comparison trial of women with moderate to severe idiopathic UUI included 126 participants initiating AC plus P bladder injection and 121 receiving P pills plus Botox injection. Adherence data on 243 participants (124 AC and 119 P) were calculated by pill count and MEMSCAP data for each 2-month interval during the 6-month study that allowed for dose escalation/drug change. Overall composite adherence estimates were calculated using the average of both methods and weighted by the duration of each 2-month interval. RESULTS Treatment groups had no significant differences in dosing duration (P = 0.76) or mean adherence (AC, 83.3% [16.8] vs. P, 84.8% [13.8]). Only 53% of women met the dichotomous outcome of more than 80% adherence during all intervals. Correlation between adherence by pill counts versus MEMSCAP decreased over time with pill counts demonstrating higher adherence than MEMSCAP (r = 0.53, 0.50, and 0.36 for each 2-month interval). Lower adherence was associated with higher baseline incontinence severity and better UUI quality of life for the AC group and with current smoking status in both groups. CONCLUSIONS Adherence using pill counts and MEMSCAP was reasonably correlated and similar in both the AC and P groups. In the AC group, higher baseline incontinence severity and better UUI Quality of Life were associated with decreased adherence. Smokers were less adherent.
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Pindelska E, Szeleszczuk L, Pisklak DM, Majka Z, Kolodziejski W. Crystal structures of tiotropium bromide and its monohydrate in view of combined solid-state nuclear magnetic resonance and gauge-including projector-augmented wave studies. J Pharm Sci 2015; 104:2285-92. [PMID: 25981387 DOI: 10.1002/jps.24490] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/09/2015] [Accepted: 04/15/2015] [Indexed: 12/19/2022]
Abstract
Tiotropium bromide is an anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease. The crystal structures of this compound and its monohydrate have been previously solved and published. However, in this paper, we showed that those structures contain some major errors. Our methodology based on combination of the solid-state nuclear magnetic resonance (NMR) spectroscopy and quantum mechanical gauge-including projector-augmented wave (GIPAW) calculations of NMR shielding constants enabled us to correct those errors and obtain reliable structures of the studied compounds. It has been proved that such approach can be used not only to perform the structural analysis of a drug substance and to identify its polymorphs, but also to verify and optimize already existing crystal structures.
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Affiliation(s)
- Edyta Pindelska
- Faculty of Pharmacy, Medical University of Warsaw, Department of Inorganic and Analytical Chemistry, Warsaw, 02-093, Poland
| | - Lukasz Szeleszczuk
- Faculty of Pharmacy, Medical University of Warsaw, Department of Physical Chemistry, Warsaw, 02-093, Poland
| | - Dariusz Maciej Pisklak
- Faculty of Pharmacy, Medical University of Warsaw, Department of Physical Chemistry, Warsaw, 02-093, Poland
| | - Zbigniew Majka
- Pharmaceutical Company Adamed Ltd., Czosnów, 05-152, Poland
| | - Waclaw Kolodziejski
- Faculty of Pharmacy, Medical University of Warsaw, Department of Inorganic and Analytical Chemistry, Warsaw, 02-093, Poland
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Baclofen dosage after traumatic spinal cord injury: A multi-decade retrospective analysis. Clin Neurol Neurosurg 2015; 129:50-6. [DOI: 10.1016/j.clineuro.2014.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/16/2014] [Accepted: 11/29/2014] [Indexed: 11/24/2022]
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Simoens S. Cost-effectiveness of pharmacotherapy for COPD in ambulatory care: a review. J Eval Clin Pract 2013; 19:1004-11. [PMID: 23590144 DOI: 10.1111/jep.12034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This article conducts a literature review about the cost-effectiveness of pharmacotherapy for chronic obstructive pulmonary disease (COPD) in ambulatory care. METHODS Relevant economic evaluations were identified by searching Medline (PubMed) and the National Health Service (NHS) Economic Evaluation Database. The search strategy focused on literature reviews and primary economic evaluations. Economic evaluations were included, which compared pharmacotherapy for COPD, chronic bronchitis or pulmonary emphysema with an alternative in terms of costs and health outcomes. RESULTS The majority of economic evaluations show that pharmacotherapy for COPD in ambulatory care is cost-effective. Cost-effectiveness derives from an improvement in lung function and a reduction in the number of exacerbations, which translates into cost savings from fewer hospitalizations. Pharmacotherapy also tends to be more cost-effective in patients with more severe COPD. When applying these results to a specific country or setting, the cost-effectiveness of pharmacotherapy will depend on the distribution of COPD severity among patients, the alternative with which pharmacotherapy is compared, the impact of pharmacotherapy on exacerbations, costs and treatment patterns of exacerbations, and price of pharmacotherapy. Economic evaluations tended to suffer from short-time horizons, restricted scope of included costs and use of various health outcome measures. CONCLUSIONS There is a case to be made in favour of economic evaluations from the societal perspective that are based on a decision-analytic model to allow for extrapolation beyond the duration of clinical trials and that use generic health outcome measures such as quality-adjusted life years.
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Affiliation(s)
- Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
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Integrating Values and Consumer Involvement in Guidelines with the Patient at the Center. Ann Am Thorac Soc 2012; 9:262-8. [DOI: 10.1513/pats.201208-061st] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Mapel DW, Roberts MH. New clinical insights into chronic obstructive pulmonary disease and their implications for pharmacoeconomic analyses. PHARMACOECONOMICS 2012; 30:869-85. [PMID: 22852587 PMCID: PMC3625413 DOI: 10.2165/11633330-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death and disability worldwide, but before the development of several new pharmacological treatments little could be done for COPD patients. Recognition that these new treatments could significantly improve the prognosis for COPD patients has radically changed clinical management guidelines from a palliative philosophy to an aggressive approach intended to reduce chronic symptoms, improve quality of life and prolong survival. These new treatments have also sparked interest in COPD cost-effectiveness research. Most COPD cost-effectiveness studies have been based on clinical trial populations, limited to direct medical costs, and used standard analysis methods such as Markov modelling, and they have usually found that newer therapies have favourable cost effectiveness. However, new insights into the clinical progression of COPD bring into question some of the assumptions underlying older analyses. In this review, we examine clinical factors unique to COPD and recent changes in clinical perspectives that have important implications for pharmacoeconomic analyses. The main parameters explored include (i) the high indirect medical costs for COPD and their relevance in assessing the societal benefits of new therapy; (ii) the importance of acute deteriorations in COPD, known as exacerbations, and approaches to modelling the cost benefit of exacerbation reduction; (iii) quality/utility instruments for COPD; (iv) the prevalence of co-morbid conditions and confounding between COPD and co-morbid disease utilization; (v) the limitations of Markov modelling; and (vi) the problem of outliers.
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Affiliation(s)
- Douglas W Mapel
- Lovelace Clinic Foundation, Albuquerque, MN 87106-4264, USA.
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Machado Fonseca MC. Ilusão ou realidade, arte abstrata ou concreta? Modelos em saúde: eles respondem as perguntas? Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000300001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fonseca MCM. Illusion or reality, abstract or concrete art? Models in health: do they answer the questions? Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rutten-van Mölken MPMH, Goossens LMA. Cost effectiveness of pharmacological maintenance treatment for chronic obstructive pulmonary disease: a review of the evidence and methodological issues. PHARMACOECONOMICS 2012; 30:271-302. [PMID: 22409290 DOI: 10.2165/11589270-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Over 200 million people have chronic obstructive pulmonary disease (COPD) worldwide. The number of disease-year equivalents and deaths attributable to COPD are high. Guidelines for the pharmacological treatment of the disease recommend an individualized step-up approach in which treatment is intensified when results are unsatisfactory. OBJECTIVE Our objective was to present a systematic review of the cost effectiveness of pharmacological maintenance treatment for COPD and to discuss the methodological strengths and weaknesses of the studies. METHODS A systematic literature search for economic evaluations of drug therapy in COPD was performed in MEDLINE, EMBASE, the Economic Evaluation Database of the UK NHS (NHS-EED) and the European Network of Health Economic Evaluation Databases (EURONHEED). Full economic evaluations presenting both costs and health outcomes were included. RESULTS A total of 40 studies were included in the review. Of these, 16 were linked to a clinical trial, 14 used Markov models, eight were based on observational data and two used a different approach. The few studies on combining short-acting bronchodilators were consistent in finding net cost savings compared with monotherapy. Studies comparing inhaled corticosteroids (ICS) with placebo or no maintenance treatment reported inconsistent results. Studies comparing fluticasone with salmeterol consistently found salmeterol to be more cost effective. The cost-effectiveness studies of tiotropium versus placebo, ipratropium or salmeterol pointed towards a reduction in total COPD-related healthcare costs for tiotropium in many but not all studies. All of these studies reported additional health benefits of tiotropium. The cost-effectiveness studies of the combination of inhaled long-acting β₂-agonists and ICS all report additional health benefits at an increase in total COPD-related costs in most studies. The cost-per-QALY estimates of this combination treatment vary widely and are very sensitive to the assumptions on mortality benefit and time horizon. CONCLUSIONS The currently available economic evaluations indicate differences in cost effectiveness between COPD maintenance therapies, but for a more meaningful comparison of results it is important to improve the consistency with respect to study methodology and choice of comparator.
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Affiliation(s)
- Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment/Institute for Healthcare Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
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Donner CF, Virchow JC, Lusuardi M. Pharmacoeconomics in COPD and inappropriateness of diagnostics, management and treatment. Respir Med 2011; 105:828-37. [DOI: 10.1016/j.rmed.2010.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/29/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
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Zimovetz EA, Wilson K, Samuel M, Beard SM. A review of cost-effectiveness of varenicline and comparison of cost-effectiveness of treatments for major smoking-related morbidities. J Eval Clin Pract 2011; 17:288-97. [PMID: 21029268 DOI: 10.1111/j.1365-2753.2010.01439.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE This review aims to examine economic evaluations of varenicline, to compare the reported cost-effectiveness of varenicline with that of treatments for major smoking-related diseases and to evaluate the findings for decision making. METHODS A literature search was performed to identify published articles in English indexed in MEDLINE and the Cochrane Library (Issue 1, 2009), which includes the Economic Evaluation Database. Additional sources also were searched to identify unpublished varenicline studies, including conference abstracts. The search for varenicline studies was limited from 2006 to October 2009; searches for all other types of studies were limited from 1990 to October 2009. RESULTS The search yielded a total of 20 relevant economic evaluations of varenicline. In addition, 37 reviews of economic evaluations in chronic obstructive pulmonary disease, non-small cell lung cancer and cardiovascular disease, as well as studies evaluating the impact of economic rewarding were considered in this review. From these identified economic evaluations, the incremental cost-effectiveness ratios for varenicline ranged from dominance (more effective and cost saving) to €18,582 per quality-adjusted life-year (including indirect costs). These estimates appeared substantially lower when compared with incremental cost-effectiveness ratios reported for secondary prevention of smoking-related diseases, which in some cases were as high as €66,218 per quality-adjusted life-year. CONCLUSIONS Varenicline appears to be cost-effective from the perspective of both health care payers and employers, because of reduced health care consumption and costs. The cost-effectiveness of varenicline also compares favourably to that of interventions recommended for the treatment and prevention of smoking-related diseases.
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Affiliation(s)
- Evelina A Zimovetz
- Senior Health Technology and Clinical Evidence Reviewer, Head of European Operations, RTI Health Solutions, Williams House, Manchester Science Park, Manchester, UK.
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Donner CF, Lusuardi M. COPD a social disease: inappropriateness and pharmaco-economics. The role of the specialist: present and future. Multidiscip Respir Med 2010; 5:437-49. [PMID: 22958390 PMCID: PMC3463056 DOI: 10.1186/2049-6958-5-6-437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 11/22/2010] [Indexed: 11/10/2022] Open
Affiliation(s)
- Claudio F Donner
- Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero (NO), Italy.
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Wang Y, Bai C, Wang X. COPD-associated vascular pathology: a future targeting area. Expert Rev Respir Med 2010; 2:297-9. [PMID: 20477192 DOI: 10.1586/17476348.2.3.297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mapel DW, Schum M, Lydick E, Marton JP. A new method for examining the cost savings of reducing COPD exacerbations. PHARMACOECONOMICS 2010; 28:733-49. [PMID: 20799755 DOI: 10.2165/11535600-000000000-00000] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Some treatments for chronic obstructive pulmonary disease (COPD) can reduce exacerbations, and thus could have a favourable impact on overall healthcare costs. OBJECTIVE To evaluate a new method for assessing the potential cost savings of COPD controller medications based on the incidence of exacerbations and their related resource utilization in the general population. METHODS Patients with COPD (n = 1074) enrolled in a regional managed care system in the US were identified using administrative data and divided by their medication use into three groups (salbutamol, ipratropium and salmeterol). Exacerbations were captured using International Classification of Diseases, Ninth Edition (ICD-9) and current procedural terminology (CPT) codes, then logistic regression models were created that described the risk of exacerbations for each comparator group and exacerbation type over a 6-month period. A Monte Carlo simulation was then applied 1000 times to provide the range of potential exacerbation reductions and cost consequences in response to a range of hypothetical examples of COPD controller medications. RESULTS Exacerbation events for each group could be modelled such that the events predicted by the Monte Carlo estimates were very close to the actual prevalences. The estimated cost per exacerbation avoided depended on the incidence of exacerbation in the various subpopulations, the assumed relative risk reduction, the projected daily cost for new therapy, and the costs of exacerbation treatment. CONCLUSIONS COPD exacerbation events can be accurately modelled from the healthcare utilization data of a defined cohort with sufficient accuracy for cost-effectiveness analysis. Treatments that reduce the risk or severity of exacerbations are likely to be cost effective among those patients who have frequent exacerbations and hospitalizations.
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Affiliation(s)
- Douglas W Mapel
- Lovelace Clinic Foundation, Albuquerque, New Mexico 87106-4264, USA.
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Arnold RJG, Ekins S. Time for cooperation in health economics among the modelling community. PHARMACOECONOMICS 2010; 28:609-13. [PMID: 20513161 DOI: 10.2165/11537580-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Renée J G Arnold
- Master of Public Health Program, Mount Sinai School of Medicine, Department of Preventive Medicine, New York, NY 10119, USA.
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Gauhar U, Dransfield M, Cooper JAD. Sequential comparison of tiotropium to high-dose ipratropium in patients with chronic obstructive pulmonary disease in a practice setting. Int J Chron Obstruct Pulmon Dis 2009; 4:391-5. [PMID: 19888357 PMCID: PMC2771709 DOI: 10.2147/copd.s7566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the effect of changing anticholinergic therapy in patients with COPD from ipratropium to tiotropium on pulmonary function. METHODS We examined records of patients prescribed high-dose ipratropium, who were subsequently converted to tiotropium. Spirometric values were obtained within 2 days of the change in medication and after 56 to 224 days of the switch to tiotropium. RESULTS 15 subjects were documented to have filled a prescription for ipratropium-containing medications the month prior to the change. Medication compliance over the 6 months prior to the switch in these patients was 72% +/- 31% (mean +/- SD) for ipratropium compared to 87% +/- 14% for tiotropium over the 6-month period after the switch (P = 0.1). FEV(1) improved from 1.12 +/- 0.39 L at baseline to 1.37 +/- 0.49 L after the change to tiotropium (P = 0.01). FVC also improved from 2.45 +/- 0.73 L at baseline to 2.72 +/- 0.69 L after the change (P = 0.04). Maximal voluntary ventilation was also increased from 39.67 +/- 10.7 L/min to 45.13 +/- 15.8 L/min (P = 0.045). CONCLUSIONS We conclude that replacing high-dose ipratropium with tiotropium therapy significantly improves pulmonary function in a clinical setting.
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Affiliation(s)
- Umair Gauhar
- Pulmonary Section, Birmingham Veterans Affairs Medical Center and Division of Allergy, Pulmonary and Critical Medicine University of Alabama at Birmingham, AL, USA
| | - Mark Dransfield
- Pulmonary Section, Birmingham Veterans Affairs Medical Center and Division of Allergy, Pulmonary and Critical Medicine University of Alabama at Birmingham, AL, USA
| | - J Allen D Cooper
- Pulmonary Section, Birmingham Veterans Affairs Medical Center and Division of Allergy, Pulmonary and Critical Medicine University of Alabama at Birmingham, AL, USA
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Akazawa M, Stearns SC, Biddle AK. Assessing treatment effects of inhaled corticosteroids on medical expenses and exacerbations among COPD patients: longitudinal analysis of managed care claims. Health Serv Res 2008; 43:2164-82. [PMID: 18671750 PMCID: PMC2614004 DOI: 10.1111/j.1475-6773.2008.00879.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). DATA SOURCES Claims between 1997 and 2005 from a large managed care database. STUDY DESIGN Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. DATA EXTRACTION METHODS COPD patients aged 40 or older with > or = 15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. PRINCIPAL FINDINGS ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients > or = 50 years old, ICS was cost saving 57 percent of time. CONCLUSIONS ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates.
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Affiliation(s)
- Manabu Akazawa
- Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB# 7411, Chapel Hill, NC 27599-7411, USA
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Abstract
Modern burn care is a resource intensive endeavor requiring specialized equipment, personnel, and facilities in order to provide optimum care. The costs associated with burn injury to both patients and society as a whole can be multifaceted and large. The purpose of this study was to evaluate the association between hospital costs, patient characteristics, and injury factors in a cohort of pediatric patients admitted to a regional burn center. We performed a review of the hospital charges accrued by pediatric patients (age <16 years) admitted to our burn center from 1994 to 2004 and explored the relationship between baseline patient, injury and hospital course characteristics and total costs. Hospital charges were converted to 2005 dollar costs using an inflation index and a cost to charge ratio. Univariate and multivariate regressions were performed to identify the factors most significantly associated with cost. In addition, we performed a subset cost analysis for patients with burns more than 20% TBSA. A total of 1443 pediatric patients (age <16) were admitted to our burn center during the study period. The overall mean hospital cost in 2005 dollars was dollars 9026 (SD = dollars 25,483; median = dollars 2138). Area of full thickness burn was the only patient or injury factor significantly associated with greater hospital costs (P < .05) on multivariate analysis. No single anatomic area was associated with increased hospital costs when adjusted for total overall burn size. Injury severity was the most significant factor impacting index hospitalization costs following pediatric burn injury. Further studies defining the long-term societal costs impact of burn injury are needed as are studies that evaluate the impact of burn injury on quality of life.
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Dal Negro R. Optimizing economic outcomes in the management of COPD. Int J Chron Obstruct Pulmon Dis 2008; 3:1-10. [PMID: 18488425 PMCID: PMC2528207 DOI: 10.2147/copd.s671] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention to COPD is increasing worldwide because its high prevalence, morbidity, and mortality present a challenging problem for all healthcare systems. The burden of COPD, which is usually measured in terms of progressive lung function decline, impact on patients' symptoms, patient's disability, and quality of life, together with the corresponding use of health care resources, is still a major aspect of the disease. Recommendations to treat COPD according to the most accepted guidelines have expanded in recent years even though COPD still remains unacceptably under-diagnosed and under-treated worldwide. Obviously, more severe degrees of COPD receive major attention both in terms of monitoring of clinical outcomes and of assessing the economic value of therapeutic interventions. The role of different strategies against COPD should be valued on the basis of their effectiveness in outcome optimization, which primarily depends on the efficacy of prevention activities and of early diagnosis programs. It is generally agreed that the main proportion of COPD burden still depends on the clinically uncontrolled disease and on its high exacerbation rate, which frequently leads to the patient hospitalization. In COPD, the effects of guideline recommendations have been only sporadically investigated in pharmaoeconomic terms, even though symptoms and disability have declined substantially; the corresponding improvement in quality of life, and a significant decrease in both direct and indirect costs have been proved to depend on appropriate rehabilitative and pharmacological long-term treatment of the disease. At present, more precise indices and more fitting outcomes are continuously sought and found in order to assess more effective strategies for controlling COPD.
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Sicras-Mainar A, Velasco-Velasco S, Llopart-López JR, Navarro-Artieda R, de Haro-Martí L. [Calculation of morbidity, use of resources and costs of patients treated with tiotropium bromide for COPD in a Spanish population]. Aten Primaria 2008; 39:547-55. [PMID: 17949628 DOI: 10.1157/13110735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine the co-morbidity and economic impact of treatment with tiotropium bromide (TB) for COPD, in a population cared for by Spanish primary care teams (PCTs) and specialist physicians, in the context of routine clinical practice. DESIGN Retrospective multi-centre study. SETTING Four PCTs and 2 urban hospitals. PARTICIPANTS Patients with COPD receiving regular treatment with TB, during 2004. MAIN MEASUREMENTS Age and sex, episodes of co-morbidity, clinical parameters, resource use, and pharmacological groups. The costs model was established by differentiating semi-fixed from variable costs (pharmacy, tests, referrals) in the PCTs, as well as the visits, emergencies and hospital admissions occurring in the hospitals. A logistical regression analysis was made to correct the model. The costs were contrasted by analysis of covariance (ANCOVA), with the estimation of marginal means (Bonferroni adjustment). RESULTS Of 900 patients with COPD, 14.3% (n=129) received treatment with TB (95% CI, 12.0%-16.6%). The mean episodes/patient/year was 2.1 (1.4) versus 1.8 (1.3) (NS), seriousness/severity 41.3% versus 26.3% (P =.001), defined daily dose (DDD) 5928.5 (9624.1) versus 6187.7 (12471.3) (NS) and number visits/patient/year 15.1 (9.4) versus 17.3(11.9) (P=.044). After adjustments for age and sex, TB use was associated with Diabetes Mellitus (OR=1.6; 95% CI, 1.0-2.5; P=.034) and severity of patients' illness (OR=1.8; 95% CI, 1.2-2.8; P=.004). Quantification of unit cost/year was 2793.16 (3166.30) euros (3359.27 [3423.25] euros versus 2703.09 [3113.75] euros; P=.001). The adjusted patient cost/year was 2831.23 euros (SE, 217.32) with TB versus 2786.86 euros (SE, 88.53) without TB (NS). CONCLUSIONS TB is associated, as therapy complementing routine treatment, with the presence of Diabetes, and with the severity of the disease. The costs of COPD entail high resource consumption. The prescription of TB does not imply greater overall cost of the disease.
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Affiliation(s)
- Antoni Sicras-Mainar
- Dirección de Planificación, Badalona Serveis Assistencials, Badalona. Barcelona, España.
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Blanc PD, Eisner MD, Yelin EH, Earnest G, Balmes JR, Gregorich SE, Katz PP. Socioeconomic gradients in tiotropium use among adults with COPD. Int J Chron Obstruct Pulmon Dis 2008; 3:483-90. [PMID: 18990978 PMCID: PMC2629974 DOI: 10.2147/copd.s3319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Inequalities in the use of new medications may contribute to health disparities. We analyzed socioeconomic gradients in the use of tiotropium for chronic obstructive pulmonary disease (COPD). METHODS In a cohort of adults with COPD aged > or = 55 years identified through population-based sampling, we elicited questionnaire responses on demographics, socioeconomic status (SES; lower SES defined as high school education or less or annual household income < US $20,000), and medication use and other clinical variables. In a subset we obtained pulmonary function testing. We used multiple logistic regression analysis to estimate the associations between SES and tiotropium use in COPD, adjusting for disease severity measured by a COPD Severity Score. RESULTS Of 427 subjects, 44 (10.3%) reported using tiotropium in 2006. Adjusting for COPD severity, lower SES was associated with reduced odds of tiotropium use (OR 0.3; 95% CI 0.1-0.7; p = 0.005). Among the subset with lung function data (n = 95), after including COPD Global Obstructive Lung Disease (GOLD) Stage > or = 2 in the model, lower SES remained associated with reduced odds oftiotropium use (OR 0.03; 95% CI < 0.001-0.7; p = 0.03). Including forced expiratory volume in one second in the model as a continuous variable instead of GOLD Stage > or = 2 yielded similar results for lower SES (OR 0.1; 95% CI < 0.001-0.5; p = 0.02). CONCLUSION There was a strong SES gradient in tiotropium use such that there was less use with lower SES. To the extent that this is an efficacious medication for COPD, this gradient represents a potential source of health disparities.
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Affiliation(s)
- Paul D Blanc
- Division of Occupational and Environmental Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94143-0924, USA.
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Arnold RJG. Cost-effectiveness analysis: should it be required for drug registration and beyond? Drug Discov Today 2007; 12:960-5. [DOI: 10.1016/j.drudis.2007.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 09/20/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
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Yawn BP, Keenan JM. COPD--the primary care perspective: addressing epidemiology, pathology, diagnosis, treatment of smoking's multiple morbidities and the patient's perspective. COPD 2007; 4:67-83. [PMID: 17364679 DOI: 10.1080/15412550601169562] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA.
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Alfageme Michavila I, Reyes Núñez N, Merino Sánchez M, Gallego Borrego J. Fármacos anticolinérgicos. Arch Bronconeumol 2007. [DOI: 10.1016/s0300-2896(07)74004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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