M. Friedman et al., Pharmacoeconomic evaluation of a combination of ipratropium plus albuterolcompared with ipratropium alone and albuterol alone in COPD, CHEST, 115(3), 1999, pp. 635-641
Citations number
23
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Study objective: To conduct a post hoc pharmacoeconomic evaluation of two d
ouble-blind, randomized, prospective, parallel group studies comparing the
long-term efficacy and safety of ipratropium combined with albuterol in a s
ingle inhalational canister against either bronchodilator agent alone in pa
tients with COPD,
Patients: One thousand sixty-seven patients with COPD.
Methods: The dose of each bronchodilator was two puffs four times a day (42
mu g of ipratropium bromide, 240 mu g of albuterol sulfate). Pulmonary fun
ction testing was performed on days 1, 29, 57, and 85 of treatment. Outcome
s, health-care;resource consumption, and costs were compared for the three
treatment groups over the 85-day study period. A total of 1,067 patients we
re randomized in the two studies (albuterol alone, n = 347; ipratropium alo
ne, n = 362; albuterol plus ipratropium, n = 358),
Results: Improvement in FEV1 and area under the FEV1 response-time curve fr
om time 0 to 4 h (FEV(1)AUC(0-4)) was significantly greater for the combina
tion of albuterol plus ipratropium than either agent alone on all test days
, Compared with albuterol, patients receiving ipratropium and ipratropium p
lus albuterol experienced significantly fewer COPD exacerbations and patien
t-days of exacerbation, In addition, the increased frequency of exacerbatio
ns observed in the albuterol group was associated with a significant increa
se in the number of patient hospital days and antibiotic and corticosteroid
use. As a result, the total cost of treatment over the study period was si
gnificantly less for ipratropium ($156 per patient) and ipratropium plus al
buterol ($197 per patient) than for albuterol ($269 per patient), Increased
cost-effectiveness, defined as total estimated treatment cost per mean cha
nge in FEV(1)AUC(0-4), was observed in both treatment arms containing iprat
ropium.
Conclusions: The inclusion of ipratropium in a pharmacologic treatment regi
men is associated with a lower rate of exacerbations in COPD, The result is
lower total treatment costs and improved cost-effectiveness.