Bollu Vamsi, Guérin Annie, Gauthier Geneviève, Hiscock Robert, Wu Eric Q
Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA.
Analysis Group, Inc., 1000 De La Gauchetiere West, Suite 1200, Montreal, QC, H3B 4W5, Canada.
Drugs Real World Outcomes. 2017 Mar;4(1):33-41. doi: 10.1007/s40801-016-0097-y.
Bronchodilators 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.
The study objective was to compare all-cause readmission risk in COPD patients receiving nebulized long-acting β-agonists (neb-LABAs) versus nebulized short-acting β-agonists (neb-SABA) following COPD-related hospitalization discharge.
This 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.
The 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).
Patients receiving neb-LABAs had a significantly lower readmission risk within 6 months following a COPD-related hospitalization versus patients treated with neb-SABAs.
支气管扩张剂用于控制慢性阻塞性肺疾病（COPD）的症状，并将住院和再入院风险降至最低。医院再入院可预测发病率和死亡率。
本研究的目的是比较慢性阻塞性肺疾病（COPD）相关住院出院后接受雾化长效β受体激动剂（neb-LABA）与雾化短效β受体激动剂（neb-SABA）治疗的COPD患者的全因再入院风险。
这项回顾性分析利用美国的药房和医疗理赔记录（2001年至2011年），确定年龄≥40岁、在与COPD相关的住院出院后30天内接受neb-LABA或neb-SABA治疗的COPD患者。患者在首次neb-LABA或neb-SABA处方配药（索引日期）前后必须连续参加其健康计划≥6个月，并在索引日期后前3个月坚持治疗。为了选择具有相似严重程度特征的患者，根据基线特征对neb-LABA和neb-SABA患者进行匹配。在索引日期后的6个月内观察再入院风险，并使用多变量Cox比例风险模型比较neb-LABA和neb-SABA队列之间的风险。
分析纳入了246例匹配患者（neb-LABA组=123例；neb-SABA组=123例）。平均年龄为67岁，54%为女性。索引住院期间的平均住院时间为4.4天。在调整潜在混杂因素后，neb-LABA队列的再入院风险比neb-SABA队列低47%（风险比0.53，95%置信区间0.30-0.96；P=0.0349）。
与接受neb-SABA治疗的患者相比，接受neb-LABA治疗的患者在COPD相关住院后6个月内的再入院风险显著降低。
