Open Access Research article

Comparison of resource use by COPD patients on inhaled therapies with long-acting bronchodilators: a database study

Chris M Kozma1, Andrew L Paris2, Craig A Plauschinat3*, Terra Slaton4 and John I Mackowiak5

Author Affiliations

1 CK Consulting, 84 Tomahawk Trail, St. Helena Island, SC, 29920, USA

2 Vigilytics LLC, 559 Fox Hunt Drive, Victor, NY, 14564, USA

3 Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, 59 Route 10, East Hanover, NJ, 07936, USA

4 308 Canaberry Drive, West Columbia, SC 29170, USA

5 Center for Outcomes Research, 3500 Woodmont Blvd, Nashville, TN, 37215, USA

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BMC Pulmonary Medicine 2011, 11:61  doi:10.1186/1471-2466-11-61

Published: 22 December 2011



The purpose of this analysis was to compare health care costs and utilization among COPD patients who had long-acting beta-2 agonist (LABA)

long-acting muscarinic antagonist (LAMA); LABA
inhaled corticosteroid (ICS) prescription claims.


This was a 12 month pre-post, retrospective analysis using COPD patients in a national administrative insurance database. Propensity score and exact matching were used to match patients 1:1:1 between the LABA or LAMA (formoterol, salmeterol, or tiotropium), LABA and LAMA (tiotropium/formoterol or tiotropium/salmeterol), and LABA, LAMA and ICS (bronchodilators plus steroid) groups. Post-period comparisons were evaluated with analysis of covariance. Costs were evaluated from a commercial payer perspective.


A total of 523 patients were matched using 29 pre-period variables (e.g., demographics, medication exposure). Post-match assessments indicated balance among the cohorts. COPD-related costs differed among groups (LABA or LAMA $2,051 SE = 91; LABA and LAMA $2,823 SE = 62; LABA, LAMA and ICS $3,546 SE = 89; all p < .0001) with the differences driven by study medication costs. However, non-study COPD medication costs were higher for the LABA or LAMA therapy group ($911 SE = 91) compared to the LABA and LAMA therapy group ($668 SE = 58; p = 0.0238) and non-study respiratory medications were approximately $100 greater for the LABA or LAMA therapy group relative to both LABA and LAMA (p = .0018) and LABA, LAMA, and ICS (p = .0071) therapy groups. While there was no observed difference in outpatient costs, there was a slightly higher number of outpatient visits per patient in the LABA and LAMA (25.5 SE = 0.9, p = 0.0070) relative to the LABA or LAMA therapy group (22.3 SE = 0.8) and higher utilization (89.7% of patients) with COPD visits in the LABA and LAMA therapy group relative to both the LABA or LAMA (73.8%; p < .0001) and LABA, LAMA and ICS therapy groups (85.3; p = 0.0305).


Significant cost differences driven mainly by pharmaceuticals were observed among LABA or LAMA, LABA and LAMA and LABA, LAMA and ICS therapies. A COPD-related cost offset was observed from single bronchodilator to two bronchodilators. Addition of an ICS with two bronchodilators resulted in higher treatment costs without reduction in other COPD-related costs compared with two bronchodilators.