Clinical and economic outcomes of multiple versus single long-acting inhalers in COPD

Respir Med. 2011 Dec;105(12):1861-71. doi: 10.1016/j.rmed.2011.07.001. Epub 2011 Jul 31.


Objective: To compare healthcare resource utilization and healthcare costs between COPD patients who used multiple long-acting inhalers versus those who used a single long-acting inhaler.

Methods: COPD patients meeting study inclusion criteria were identified in the Market Scan database (2004-2008) and were classified as being a multiple- or single-inhaler user. 11,747 multiple- and single-inhaler users were matched on baseline characteristics to balance disease severity. Patients were followed for 12 months. Incremental differences between the two groups were estimated for: number of exacerbations; time to first exacerbation; all-cause and COPD-related inpatient admissions, inpatient days, emergency room visits, urgent care visits, outpatient visits, and other medical services visits; all-cause and COPD-related healthcare costs. Multivariate regression analyses were also used to control for a number of potentially confounding factors.

Results: After controlling for a number of potentially confounding factors, multiple-inhaler users experienced significantly more exacerbations (0.52; p < .0001) and had a higher risk of exacerbation (HR = 1.40; p < .0001) than single-inhaler users. Multiple-inhaler users also incurred significantly more inpatient admissions (IRR = 1.15; p < .0001), inpatient days (IRR = 1.20; p < .0001), urgent care visits (IRR = 1.10; p = 0.0026), outpatient visits (IRR = 1.06; p < .0001), and other medical services visits (IRR = 1.12; p = <.001) than single-inhaler users, resulting in significantly higher all-cause health care costs ($3,319; p < .0001). Results of COPD-related resource use and costs were comparable.

Conclusions: After controlling for a number of potentially confounding factors, multiple-inhaler users had more exacerbations, a higher risk of exacerbation, and higher healthcare resource utilization and costs compared to single-inhaler users.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Inhalation
  • Aged
  • Bronchodilator Agents / economics*
  • Bronchodilator Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Therapy, Combination / economics
  • Female
  • Follow-Up Studies
  • Health Care Costs*
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Matched-Pair Analysis
  • Medication Adherence / statistics & numerical data*
  • Proportional Hazards Models
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / economics*
  • Retrospective Studies


  • Bronchodilator Agents