Pharmacoeconomic evaluation of a combination of ipratropium plus albuterolcompared with ipratropium alone and albuterol alone in COPD

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.