Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment
Bartolome R Celli,1 Maryam Navaie,2,3 Zhun Xu,4 Soojin Cho-Reyes,2 Carole Dembek,5 Todd P Gilmer41Chronic Obstructive Pulmonary Disease Center, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 2Global Strategy, Advance Health Solutions, LLC, New York, NY, USA; 3School...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2019-05-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/medication-management-patterns-among-medicare-beneficiaries-with-chron-peer-reviewed-article-COPD |
| _version_ | 1819047874935128064 |
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| author | Celli BR Navaie M Xu Z Cho-Reyes S Dembek C Gilmer TP |
| author_facet | Celli BR Navaie M Xu Z Cho-Reyes S Dembek C Gilmer TP |
| author_sort | Celli BR |
| collection | DOAJ |
| description | Bartolome R Celli,1 Maryam Navaie,2,3 Zhun Xu,4 Soojin Cho-Reyes,2 Carole Dembek,5 Todd P Gilmer41Chronic Obstructive Pulmonary Disease Center, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 2Global Strategy, Advance Health Solutions, LLC, New York, NY, USA; 3School of Professional Studies, Columbia University, New York, NY, USA; 4Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; 5Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc, Marlborough, MA, USAPurpose: Global evidence-based treatment strategies for chronic obstructive pulmonary disease (COPD) recommend using long-acting bronchodilators (LABDs) as maintenance therapy. However, COPD patients are often undertreated. We examined COPD treatment patterns among Medicare beneficiaries who initiated arformoterol tartrate, a nebulized long-acting beta2 agonist (LABA), and identified the predictors of initiation.Methods: Using a 100% sample of Medicare administrative data, we identified beneficiaries with a COPD diagnosis (ICD-9 490–492.xx, 494.xx, 496.xx) between 2010 and 2014 who had ≥1 year of continuous enrollment in Parts A, B, and D, and ≥2 COPD-related outpatient visits within 30 days or ≥1 hospitalization(s). After applying inclusion/exclusion criteria, three cohorts were identified: (1) study group beneficiaries who received nebulized arformoterol (n=11,886), (2) a subset of the study group with no LABD use 90 days prior to initiating arformoterol (n=5,542), and (3) control group beneficiaries with no nebulized LABA use (n=220,429). Logistic regression was used to evaluate predictors of arformoterol initiation. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were computed.Results: Among arformoterol users, 47% (n=5,542) had received no LABDs 90 days prior to initiating arformoterol. These beneficiaries were being treated with a nebulized (50%) or inhaled (37%) short-acting bronchodilator or a systemic corticosteroid (46%), and many received antibiotics (37%). Compared to controls, beneficiaries who initiated arformoterol were significantly more likely to have had an exacerbation, a COPD-related hospitalization, and a pulmonologist or respiratory therapist visit prior to initiation (all p<0.05). Beneficiaries with moderate/severe psychiatric comorbidity or dual-eligible status were significantly less likely to initiate arformoterol, as compared to controls (all p<0.05).Conclusion: Medicare beneficiaries who initiated nebulized arformoterol therapy had more exacerbations and hospitalizations than controls 90 days prior to initiation. Findings revealed inadequate use of maintenance medications, suggesting a lack of compliance with evidence-based treatment guidelines.Keywords: long-acting beta2-agonists, arformoterol, nebulized therapy, COPD, Medicare, treatment patterns |
| first_indexed | 2024-12-21T11:07:18Z |
| format | Article |
| id | doaj.art-7608272e975147b8935230da341cfafe |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-12-21T11:07:18Z |
| publishDate | 2019-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-7608272e975147b8935230da341cfafe2022-12-21T19:06:11ZengDove Medical PressInternational Journal of COPD1178-20052019-05-01Volume 141019103145825Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatmentCelli BRNavaie MXu ZCho-Reyes SDembek CGilmer TPBartolome R Celli,1 Maryam Navaie,2,3 Zhun Xu,4 Soojin Cho-Reyes,2 Carole Dembek,5 Todd P Gilmer41Chronic Obstructive Pulmonary Disease Center, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 2Global Strategy, Advance Health Solutions, LLC, New York, NY, USA; 3School of Professional Studies, Columbia University, New York, NY, USA; 4Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; 5Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc, Marlborough, MA, USAPurpose: Global evidence-based treatment strategies for chronic obstructive pulmonary disease (COPD) recommend using long-acting bronchodilators (LABDs) as maintenance therapy. However, COPD patients are often undertreated. We examined COPD treatment patterns among Medicare beneficiaries who initiated arformoterol tartrate, a nebulized long-acting beta2 agonist (LABA), and identified the predictors of initiation.Methods: Using a 100% sample of Medicare administrative data, we identified beneficiaries with a COPD diagnosis (ICD-9 490–492.xx, 494.xx, 496.xx) between 2010 and 2014 who had ≥1 year of continuous enrollment in Parts A, B, and D, and ≥2 COPD-related outpatient visits within 30 days or ≥1 hospitalization(s). After applying inclusion/exclusion criteria, three cohorts were identified: (1) study group beneficiaries who received nebulized arformoterol (n=11,886), (2) a subset of the study group with no LABD use 90 days prior to initiating arformoterol (n=5,542), and (3) control group beneficiaries with no nebulized LABA use (n=220,429). Logistic regression was used to evaluate predictors of arformoterol initiation. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were computed.Results: Among arformoterol users, 47% (n=5,542) had received no LABDs 90 days prior to initiating arformoterol. These beneficiaries were being treated with a nebulized (50%) or inhaled (37%) short-acting bronchodilator or a systemic corticosteroid (46%), and many received antibiotics (37%). Compared to controls, beneficiaries who initiated arformoterol were significantly more likely to have had an exacerbation, a COPD-related hospitalization, and a pulmonologist or respiratory therapist visit prior to initiation (all p<0.05). Beneficiaries with moderate/severe psychiatric comorbidity or dual-eligible status were significantly less likely to initiate arformoterol, as compared to controls (all p<0.05).Conclusion: Medicare beneficiaries who initiated nebulized arformoterol therapy had more exacerbations and hospitalizations than controls 90 days prior to initiation. Findings revealed inadequate use of maintenance medications, suggesting a lack of compliance with evidence-based treatment guidelines.Keywords: long-acting beta2-agonists, arformoterol, nebulized therapy, COPD, Medicare, treatment patternshttps://www.dovepress.com/medication-management-patterns-among-medicare-beneficiaries-with-chron-peer-reviewed-article-COPDLong-acting beta2-agonistsarformoterolnebulized therapyCOPDMedicareTreatment patterns |
| spellingShingle | Celli BR Navaie M Xu Z Cho-Reyes S Dembek C Gilmer TP Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment International Journal of COPD Long-acting beta2-agonists arformoterol nebulized therapy COPD Medicare Treatment patterns |
| title | Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment |
| title_full | Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment |
| title_fullStr | Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment |
| title_full_unstemmed | Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment |
| title_short | Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment |
| title_sort | medication management patterns among medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment |
| topic | Long-acting beta2-agonists arformoterol nebulized therapy COPD Medicare Treatment patterns |
| url | https://www.dovepress.com/medication-management-patterns-among-medicare-beneficiaries-with-chron-peer-reviewed-article-COPD |
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