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* From the Section of Pulmonary Disease, Critical Care Medicine, and Environmental Medicine (Dr. Friedman), Tulane University Medical Center, School of Medicine, New Orleans, LA; Boehringer Ingelheim Pharmaceuticals, Inc (Drs. Serby, Menjoge, Wilson, and Witek), Ridgefield, CT; and Department of Pharmacy Practice (Dr. Hilleman), Creighton University School of Pharmacy and Allied Health Professions, Omaha, NE. The post hoc pharmacoeconomic analysis was supported by Boehringer Ingelheim.
Study objective: To conduct a post hoc pharmacoeconomic evaluation of two double-blind, randomized, prospective, parallel group studies comparing the long-term efficacy and safety of ipratropium combined with albuterol in a single inhalational canister against either bronchodilator agent alone in patients with COPD.
Patients: One thousand sixty-seven patients with COPD.
Methods: The dose of each bronchodilator was two puffs four times a day (42 µg of ipratropium bromide, 240 µg of albuterol sulfate). Pulmonary function testing was performed on days 1, 29, 57, and 85 of treatment. Outcomes, 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 were randomized in the two studies (albuterol alone, n = 347; ipratropium alone, n = 362; albuterol plus ipratropium, n = 358).
Results: Improvement in FEV1 and area under the FEV1 response-time curve from time 0 to 4 h (FEV1AUC0–4) was significantly greater for the combination of albuterol plus ipratropium than either agent alone on all test days. Compared with albuterol, patients receiving ipratropium and ipratropium plus albuterol experienced significantly fewer COPD exacerbations and patient-days of exacerbation. In addition, the increased frequency of exacerbations observed in the albuterol group was associated with a significant increase 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 significantly less for ipratropium ($156 per patient) and ipratropium plus albuterol ($197 per patient) than for albuterol ($269 per patient). Increased cost-effectiveness, defined as total estimated treatment cost per mean change in FEV1AUC0–4, was observed in both treatment arms containing ipratropium.
Conclusions: The inclusion of ipratropium in a pharmacologic treatment regimen is associated with a lower rate of exacerbations in COPD. The result is lower total treatment costs and improved cost-effectiveness.
Key Words: albuterol • cost-effectiveness • ipratropium • pharmacoeconomics
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