Douglas W. Mapel

Lightweight portable oxygen systems are commonly preferred by patients over compressed-oxygen systems that use E-size cylinders. However, cost is often perceived as a barrier to the prescription of lightweight portable oxygen systems. To compare the overall health-care costs of patients with COPD who used lightweight portable oxygen systems to those who used E-cylinder systems. All the patients who used either a lightweight portable oxygen system, an E-cylinder system, or an E-cylinder system, then a lightweight portable oxygen system, for at least 12 months during the study period (January 1, 1999, to December 30, 2004) were identified from the administrative database of our regional managed-care system. All direct medical utilization and costs were captured for at least the first 12 months that supplemental oxygen was dispensed. Other clinical factors that affect costs (including age, sex, ethnicity, and comorbidities) were examined and adjusted for. Of the 2,725 patients who met the inclusion criteria, 203 used only a lightweight portable oxygen system, 2,268 used only an E-cylinder system, and 254 switched from an E-cylinder system to a lightweight portable oxygen system. Among the patients who used only the lightweight portable oxygen system, the median total medical costs in the first year were nonsignificantly lower than those who used an E-cylinder system ($6,515/y vs $9,503/y). The cost difference remained nonsignificant after adjustment for clinical factors. Among the patients who switched from one system to the other in the first year, mean monthly health-care costs while using the lightweight portable oxygen system ($1,428) were not significantly different than when using the E-cylinder system ($1,396). The type of oxygen system used did not significantly affect overall cost of care in patients with COPD on long-term oxygen therapy.

Recent retrospective studies have suggested that use of inhaled corticosteroids (ICS) may improve survival in chronic obstructive pulmonary disease (COPD), particularly when combined with a long-acting beta-agonist (LABA). However, the study methodologies have been questioned, and no study has examined the survival effect of the newer combination ICS/LABA inhalers. The goal of this project was to further examine the relationship between ICS treatment, with or without LABA, and survival in COPD. COPD patients were identified from the administrative databases of four different integrated health care delivery systems. All patients who were diagnosed with COPD between September 1, 2000 and August 31, 2001 and who had at least 3 months treatment with either a combined fluticasone/salmeterol inhaler (FSI, N = 866), any ICS used with a LABA (ICS/LABA, N = 525), ICS alone (N = 742), LABA alone (N = 531), or a short-acting bronchodilator alone (SABD, N = 1832), were included. Analyses were conducted using three different analysis approaches that adjust for various biases that may affect the results. In the basic Cox proportional hazards models, use of FSI, ICS/LABA, ICS alone, and LABA alone had significant survival benefits as compared to SABD, after adjustment for differences in age, gender, comorbidities, asthma status, and disease severity (HRs 0.61 [0.45–0.83], 0.59 [0.46–0.77], 0.76 [0.61–0.95], 0.75 [0.57–0.98], respectively). Propensity score matching to reduce the clinical differences between the treatment groups versus the SABD reference group found very similar results. Nested case-control analyses, which are based on survival status instead of treatment, continued to show a significant survival benefit for FSI, ICS/LABA, and ICS alone. Treatment with FSI or another ICS with or without LABA is associated with improved survival in COPD. The treatment benefit is reproducible and is robust to application of a number of different analysis techniques designed to adjust for differences in confounding variables and for bias by indication.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of death in the United States, but most persons who have airflow obstruction have never been diagnosed with lung disease. T...

Persons with Chronic Obstructive Pulmonary Disease (COPD) are at risk for developing other smoking-related complications, including cardiac and vascular diseases. Information about the prevalence a...

We examined the direct medical costs for patients with osteoarthritis (OA) and chronic back pain (CBP) in comparison to similar patients not treated for these conditions. All persons age 18 years and over enrolled in the Lovelace Health Plan (LHP) who had at least 2 outpatient or one inpatient visits during the study period (June 30, 2000 to July 1, 2001) for OA or CBP were identified using discharge billing records. Each patient with OA or CBP was matched to 3 persons of the same age group, sex, and ethnicity, and then utilization and pharmacy records for each study subject were abstracted for comparison. The prevalence of OA and CBP increased with age (11.0% and 7.2% of persons in the 75-79 age group, respectively), although more than two-thirds of OA and CBP patients in the LHP were below age 65. Patients with OA or CBP were more than 3 times more likely than controls to be admitted to hospital, and their average length of stay, costs per hospital day, and readmission rate were all significantly higher (p < 0.01). However, only 58.8% of the excess admissions in the OA group and 48.8% of the excess admissions in the CBP group were attributed to musculoskeletal disease. Outpatient costs were more than doubled among both OA and CBP cases (mean annual outpatient costs of US dollars 4684 and US dollars 4350, respectively), with increased costs seen in all service areas. Prescription drug costs for OA patients (mean average wholesale price, AWP, US dollars 1184) were increased by 102%, with the greatest increases seen in the use of nonsteroidal antiinflammatory drugs (NSAID), gastric acid secretion reducers, and antidepressants. Prescription drug costs for CBP patients were increased by 107% (mean AWP US dollars 1331), with the greatest increases seen in the use of antidepressants, NSAID, narcotics, and gastric acid secretion reducers. Health services and prescription medication costs for patients with OA and CBP were more than double those of matched controls. Much of the increased utilization occurred in areas not commonly associated with musculoskeletal conditions.