Hospital and emergency department utilization associated with treatment for chronic obstructive pulmonary disease in a managed-care Medicare population

Curr Med Res Opin. 2009 Nov;25(11):2729-35. doi: 10.1185/03007990903267157.


Background: Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with high morbidity and mortality among older and disabled adults. Few studies have examined the comparative effectiveness of maintenance therapies for chronic obstructive pulmonary disease (COPD) in this vulnerable population.

Objectives: The study aims to compare healthcare resource utilization associated with hospitalization or emergency department (ED) visits between FDA-approved inhaled corticosteroid/long-acting beta-agonist combinations [fluticasone propionate 250 microg/salmeterol 50 microg combination (FSC)] and anticholinergic treatments (ATC) in managed-care Medicare beneficiaries with COPD.

Research design and methods: Data from the Integrated Health Care Information Systems (IHCIS) National Managed Care Benchmark Database was used in this retrospective, observational cohort study. The cohort consisted of managed-care Medicare beneficiaries with a diagnosis of COPD [International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM) codes 491.xx, 492.xx, or 496.xx] without evidence of comorbid asthma (ICD-9-CM 493.xx) who received treatment with FSC or ATC between 2003 and 2005. Cox proportional hazards regression models were conducted to examine the risk of all-cause and COPD-related hospitalizations and emergency department (ED) visits.

Results: COPD patients treated with FSC had a 18% lower risk of a COPD-related hospitalization (HR = 0.82; 95% CI = 0.75, 0.89) and an ED visit (HR = 0.82; 95% CI = 0.76, 0.89) compared to patients treated with ATC. Findings were similar for all-cause utilization (hospitalization HR = 0.83; 95% CI = 0.78, 0.88; ED visit HR = 0.84; 95% CI = 0.80, 0.88).

Conclusions: FSC is associated with a lower risk of COPD-related exacerbation events relative to ATC in managed-care Medicare beneficiaries with COPD. Findings from this study are only generalizable to managed-care Medicare beneficiaries residing in the community.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adult
  • Aged
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives
  • Androstadienes / administration & dosage
  • Comoros
  • Cost of Illness
  • Drug Combinations
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Fluticasone-Salmeterol Drug Combination
  • Health Resources / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Hospitals / statistics & numerical data*
  • Humans
  • Male
  • Managed Care Programs / statistics & numerical data
  • Medicare* / statistics & numerical data
  • Middle Aged
  • Population
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • United States / epidemiology


  • Androstadienes
  • Drug Combinations
  • Fluticasone-Salmeterol Drug Combination
  • Albuterol