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* From the Department of Epidemiology and Biostatistics (Mr. Benayoun), McGill University; the Pharmacoepidemiology Research Unit (Dr. Suissa), Division of Clinical Epidemiology, Royal Victoria Hospital; and the Division of Respiratory Medicine (Dr. Ernst), Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Correspondence to: Samy Suissa, PhD, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, Quebec, Canada H3A 1A1; e-mail: samy.suissa{at}clinepi.mcgill.ca
Background: Treatment guidelines recommend concomitant use of ipratropium bromide and inhaled ß2-agonists as severity of COPD progresses. While the use of these two agents in a single inhaler may enhance patient compliance and result in cost savings, it may, by itself, increase medication use. We assessed whether the introduction of a combined inhaled bronchodilator in the treatment of COPD modifies the use and costs related to prescribed medications.
Method: A cohort of subjects 
45 years
old initiating treatment with either a combined inhaled bronchodilator
(641 subjects) or ipratropium bromide and inhaled
ß2-agonist (411 subjects) between July 1, 1996, and June
30, 1997, was identified using the Saskatchewan Health databases. The
primary outcomes were prescribed medication usage and the subsequent
related costs during a 1-year follow-up period. Poisson regression
analysis was used to estimate rate ratios (RRs) adjusted for drug use
and hospitalization during the year prior to cohort entry.
Results: The adjusted RR of inhaled bronchodilator use was elevated for combined inhaled bronchodilator therapy (adjusted RR, 1.16; 95% confidence interval [CI], 1.07 to 1.26). However, the overall costs associated with these inhaled bronchodilators were reduced with combined inhaled bronchodilator therapy (adjusted mean ratio, 0.83; 95% CI, 0.76 to 0.92). The rate of use of other respiratory drugs and antibiotics was similar (adjusted RR, 1.03; 95% CI, 0.93 to 1.16). Applying the rate ratio for cost savings to all new, combined inhaled bronchodilator users led to estimated annual savings in Canadian dollars of $103,468 (95% CI, $48,694 to $146,082) in this province.
Conclusion: The introduction of a simpler bronchodilator dosing regimen did not significantly alter the treatment of COPD and resulted in appreciable cost savings.
Key Words: bronchodilator agents • databases • economics • obstructive lung diseases
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