呼吸事件后接受雾化阿福特罗治疗的慢性阻塞性肺疾病医疗保险受益人的病情加重、卫生资源利用及费用情况
Exacerbations, Health Resource Utilization, and Costs Among Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease Treated with Nebulized Arformoterol Following a Respiratory Event.
作者信息
Navaie Maryam, Celli Bartolome R, Xu Zhun, Cho-Reyes Soojin, Dembek Carole, Gilmer Todd P
机构信息
Advance Health Solutions, New York, New York.
School of Professional Studies, Columbia University, New York, New York.
出版信息
Chronic Obstr Pulm Dis. 2019 Oct 23;6(4):297-307. doi: 10.15326/jcopdf.6.4.2019.0127.
BACKGROUND
Long-acting beta2-agonists (LABAs), with or without inhaled corticosteroids (ICSs), delivered by handheld inhalers or nebulizers are recommended as maintenance therapy in chronic obstructive pulmonary disease (COPD). This study evaluated exacerbations, health resource utilization (HRU), and costs among Medicare beneficiaries with COPD on handheld ICS+LABA who switched to nebulized arformoterol (ARF) or continued ICS+LABA following a respiratory event.
METHODS
Using Medicare claims, we identified beneficiaries with COPD (international classification of disease, 9th revision, clinical modification [ICD-9-CM] 490-492.xx, 494.xx, 496.xx) between 2010-2014 who had ≥ 1 year of continuous enrollment in Parts A, B, and D; ≥ 2 COPD-related outpatient visits ≥ 30 days apart or ≥ 1 hospitalization(s); ICS+LABA use 90-days before ARF initiation; and a respiratory event (COPD-related hospitalization or emergency department [ED] visit < 30 days before ARF initiation). Using propensity scores, 423 beneficiaries who switched to ARF were matched to 423 beneficiaries who continued on handheld ICS+LABA (controls). Difference-in-difference regression models examined outcomes at 180-days follow-up.
RESULTS
Beneficiaries who switched to ARF had 1.5 fewer exacerbations (=0.015) but no difference in hospitalizations and ED visits compared to controls. Durable medical equipment (DME) costs were higher among ARF users than controls ($1590), yet total health care costs were similar due to cost offsets by ARF in pharmacy (-$794), inpatient (-$524), and outpatient care (-$65). ARF accounted for 55% ($886.63) of DME costs, with the remaining costs attributed to oxygen therapy ($428.10) and nebulized corticosteroids ($590.85).
CONCLUSIONS
Switching from handheld ICS+LABA to nebulized ARF resulted in fewer COPD exacerbations among Medicare beneficiaries. Nebulized LABAs may improve outcomes in selected patients with COPD.
背景
长效β2受体激动剂（LABAs），无论是否联合吸入性糖皮质激素（ICSs），通过手持吸入器或雾化器给药，被推荐作为慢性阻塞性肺疾病（COPD）的维持治疗药物。本研究评估了在发生呼吸事件后，从使用手持ICS+LABA转换为雾化阿福特罗（ARF）或继续使用ICS+LABA的COPD医疗保险受益人的病情加重情况、卫生资源利用（HRU）及费用。
方法
利用医疗保险理赔数据，我们确定了2010年至2014年间患有COPD（国际疾病分类第九版临床修订本[ICD-9-CM]490-492.xx、494.xx、496.xx），且在A、B、D部分连续参保≥1年；有≥2次间隔≥30天的与COPD相关的门诊就诊或≥1次住院治疗；在开始使用ARF前90天内使用过ICS+LABA；以及发生过呼吸事件（在开始使用ARF前<30天有与COPD相关的住院治疗或急诊科就诊）的受益人。利用倾向得分，将423名转换为ARF的受益人与423名继续使用手持ICS+LABA的受益人（对照组）进行匹配。差异-差异回归模型在180天随访时检查结果。
结果
与对照组相比，转换为ARF的受益人病情加重次数减少1.5次（P=0.015），但住院治疗和急诊科就诊次数无差异。ARF使用者的耐用医疗设备（DME）费用高于对照组（1590美元），但由于ARF在药房（-794美元）、住院（-524美元）和门诊护理（-65美元）方面的费用抵消，总医疗费用相似。ARF占DME费用的55%（886.63美元），其余费用归因于氧疗（428.10美元）和雾化糖皮质激素（590.85美元）。
结论
从手持ICS+LABA转换为雾化ARF可使医疗保险受益人的COPD病情加重次数减少。雾化LABAs可能改善部分COPD患者的治疗效果。
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