Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment
Authors Celli BR, Navaie M, Xu Z, Cho-Reyes S, Dembek C, Gilmer TP
Received 22 December 2018
Accepted for publication 25 April 2019
Published 15 May 2019 Volume 2019:14 Pages 1019—1031
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Ms Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Bartolome R Celli,1 Maryam Navaie,2,3 Zhun Xu,4 Soojin Cho-Reyes,2 Carole Dembek,5 Todd P Gilmer4
1Chronic 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, USA
Purpose: 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
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