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A New Method for Examining the Cost Savings of Reducing COPD Exacerbations

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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. AMonte 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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Acknowledgements

This study was funded by a grant from Pfizer Pharmaceuticals, Inc.

Dr Marton is an employee of, and owns common stocks in, Pfizer Pharmaceuticals, Inc., and participated in the design, data interpretation and manuscript development. Dr Mapel has been funded for this and other research projects by Pfizer Pharmaceuticals, Inc., Boehringer-Ingelheim, Inc. and GlaxoSmithKline, Inc., and he is on the speaker’s bureaus and has served as a consultant for each of these companies. Drs Schum and Lydick have no conflicts of interest to disclose.

The authors wish to thank Dr Leila Nelson for her assistance with data abstraction and statistical program development.

Author information

Correspondence to Douglas W. Mapel MD MPH.

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Mapel, D.W., Schum, M., Lydick, E. et al. A New Method for Examining the Cost Savings of Reducing COPD Exacerbations. Pharmacoeconomics 28, 733–749 (2010). https://doi.org/10.2165/11535600-000000000-00000

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Keywords

  • Chronic Obstructive Pulmonary Disease
  • Chronic Obstructive Pulmonary Disease Patient
  • Salmeterol
  • Tiotropium
  • Ipratropium