HM Medical Clinic

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ITINERARIO FORMATIVO EN DERMATOLOGÍA MÉDICO-QUIRÚRGICA Y VENEREOLOGÍA COMPLEJO HOSPITALARIO UNIVERSITARIO DE SANTIAGO DE COMPOSTELA FECHA DE ACTUALIZACIÓN: 31 de enero de 2015 Manuel Ginarte Val Mª Dolores Sánchez-Aguilar TUTORES DE RESIDENTES 1. RECURSOS Y ACTIVIDADES DEL SERVICIO

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Pharmacoeconomic Evaluation of aCombination of Ipratropium PlusAlbuterol Compared With IpratropiumAlone and Albuterol Alone in COPD* Mitchell Friedman, MD, FCCP; Charles W. Serby, MD;Shailendra S. Menjoge, PhD; J. Douglas Wilson, MB, PhD;Daniel E. Hilleman, Pharm D, FCCP; and Theodore J. Witek, Jr., Dr. PH 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 ofipratropium combined with albuterol in a single inhalational canister against either bronchodi-lator 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 mg of ipratropiumbromide, 240 mg 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 comparedfor the three treatment groups over the 85-day study period. A total of 1,067 patients wererandomized in the two studies (albuterol alone, n 5 347; ipratropium alone, n 5 362; albuterolplus ipratropium, n 5 358).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 thaneither agent alone on all test days. Compared with albuterol, patients receiving ipratropium andipratropium plus albuterol experienced significantly fewer COPD exacerbations and patient-daysof exacerbation. In addition, the increased frequency of exacerbations observed in the albuterolgroup was associated with a significant increase in the number of patient hospital days andantibiotic and corticosteroid use. As a result, the total cost of treatment over the study period wassignificantly less for ipratropium ($156 per patient) and ipratropium plus albuterol ($197 perpatient) than for albuterol ($269 per patient). Increased cost-effectiveness, defined as totalestimated treatment cost per mean change in FEV1AUC0–4, was observed in both treatment armscontaining ipratropium.Conclusions: The inclusion of ipratropium in a pharmacologic treatment regimen is associatedwith a lower rate of exacerbations in COPD. The result is lower total treatment costs andimproved cost-effectiveness.

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