Chest
Volume 119, Issue 1, January 2001, Pages 85-92
Journal home page for Chest

Clinical Investigations
COPD
The Impact of Combined Inhaled Bronchodilator Therapy in the Treatment of COPD

https://doi.org/10.1378/chest.119.1.85Get rights and content

Background:

Treatment guidelines recommend concomitantuse of ipratropium bromide and inhaled β2-agonists asseverity of COPD progresses. While the use of these two agents in asingle inhaler may enhance patient compliance and result in costsavings, it may, by itself, increase medication use. We assessedwhether the introduction of a combined inhaled bronchodilator in thetreatment of COPD modifies the use and costs related to prescribedmedications.

Method:

A cohort of subjects ≥ 45 yearsold initiating treatment with either a combined inhaled bronchodilator(641 subjects) or ipratropium bromide and inhaledβ2-agonist (411 subjects) between July 1, 1996, and June30, 1997, was identified using the Saskatchewan Health databases. Theprimary outcomes were prescribed medication usage and the subsequentrelated costs during a 1-year follow-up period. Poisson regressionanalysis was used to estimate rate ratios (RRs) adjusted for drug useand hospitalization during the year prior to cohort entry.

Results:

The adjusted RR of inhaled bronchodilator use waselevated for combined inhaled bronchodilator therapy (adjusted RR,1.16; 95% confidence interval [CI], 1.07 to 1.26). However, theoverall costs associated with these inhaled bronchodilators werereduced with combined inhaled bronchodilator therapy (adjusted meanratio, 0.83; 95% CI, 0.76 to 0.92). The rate of use of otherrespiratory drugs and antibiotics was similar (adjusted RR, 1.03; 95% CI, 0.93 to 1.16). Applying the rate ratio for cost savings to all new, combined inhaled bronchodilator users led to estimated annual savingsin Canadian dollars of $103,468 (95% CI, $48,694 to $146,082) in thisprovince.

Conclusion:

The introduction of a simplerbronchodilator dosing regimen did not significantly alter the treatmentof COPD and resulted in appreciable cost savings.

Section snippets

Source of Data

The computerized prescription and hospitalization databases of, Saskatchewan, developed as a result of the universal health insuranceprogram provided to residents of this Canadian province, constitutedthe primary source of data for this study.111213 All Saskatchewan residents (> 1 million) are eligible for coverage, withthe exception of registered Indians, members of the Armed Forces, the, Royal Canadian Mounted Police, and veterans. These exceptions represent< 5% of the population.

Demographic

Results

Among the 1,052 subjects newly treated with two differentbronchodilators, 641 subjects initiated drug therapy with the combinedinhaled bronchodilator (combined inhaled bronchodilator group) and 411subjects were dispensed, on the same day, ipratropium bromide andinhaled β2-agonist in two separate canisters(double-users group). Table 1 presentsthe sociodemographic characteristics at cohort entry. Patientsinitiated on combined inhaled bronchodilator therapy included fewerwomen and were less likely

Discussion

We conducted a study, in the context of actual medical practice, to determine the impact of the inclusion in the Saskatchewan drugformulary of a combination product hypothesized to improve patientcompliance. We found that the introduction of combined inhaledbronchodilator therapy did not significantly alter patterns of use ofbronchodilators, other respiratory drugs, and antibiotics.

The first important result of this study is that the subjects initiatedon combined inhaled bronchodilator therapy

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This study was supported through a grant from Boehringer Ingelheim Canada Ltd. Serge Benayoun was the recipient of a research fellowshipfrom the Fonds de la Recherche en Santé du Québec for theperiod of this research. Samy Suissa is a Senior Scientist of the, Medical Research Council of Canada. The Pharmacoepidemiology Research Unit is funded by an équipe grant from the Fonds de la Rechercheen Santé du Québec. This study was designed, conducted, analyzed, and interpreted independently of the sponsor.

This study is based in part on data provided by the, Saskatchewan Department of Health. The interpretation and conclusionscontained herein do not necessarily represent those of the governmentof Saskatchewan or the Saskatchewan Department of Health.

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