Table.

Studies Reporting Cost and Efficacy of Treatment of COPD Exacerbations in the United States

Study	Study design	Key findings
Trends in COPD-related healthcare costs
Blanchette et al, 201216	Longitudinal, cross-sectional surveys	Average direct per-patient medical costs for patients with COPD increased by 38% between 1987 and 2007, from $11,807 to $16,292 (2007 dollars In 2007, the largest cost was for inpatient admissions for COPD ($13,840)
Dalal et al, 201117	Longitudinal study of COPD-related health service utilization for patients with commercial insurance or Medicare Advantage	From 2006 to 2009, total direct COPD-related healthcare costs increased by approximately 6% annually among commercially insured patients and by approximately 5% in Medicare Advantage beneficiaries
Healthcare costs associated with acute COPD exacerbations
Wier et al, 201118	Analysis of the Healthcare Cost and Utilization Project data	In 2008, the aggregate cost for hospital admissions for acute COPD exacerbation was $3.8 billion
Perera et al, 201219	Analysis of the Healthcare Cost and Utilization Project data	From 2006–2010, the aggregate cost for hospitalization for acute COPD exacerbation increased from $2.96 billion to $3.47 billion (2010 dollars)
Yu et al, 201120	Analysis of service claims and cost data from the Thomson Reuters MarketScan database	In 2004–2008, the total COPD-related cost for patients with a severe exacerbation was $7014 per quarter Cost associated with COPD patients who had no exacerbations was $658 per quarter (or $2632 annually)
Pasquale et al, 201221	Analysis of claims data from a large national healthcare company for a predominately Medicare population	In 2007–2009, mean annual COPD-related healthcare cost was $12,765 for patients with a severe exacerbation The cost for moderate exacerbation was $3356 The cost for patients with no exacerbations was $1425
Dalal et al, 201122	Analysis of hospital administrative data from the Premier Perspective Database	Between 2005 and 2008 the mean cost of a COPD-related emergency room visit increased by 4.0%, to $647 In the same period the mean cost of simple hospital admissions for COPD increased by 5.9%, to $7242 Little change was seen in mean cost of complex hospital admission for COPD ($20,757 in 2008)
Maintenance therapy for preventing acute COPD exacerbation
Tashkin et al, 200823	4-year, randomized, double-blind, placebo-controlled study of inhaled tiotropium (18 µg daily) in COPD	The relative risk for first exacerbation was 0.86 (95% CI, 0.81–0.91) in the group randomized to tiotropium compared with placebo The risk of first hospitalization for an exacerbation was 0.86 (95% CI, 0.78–0.95) in patients receiving tiotropium compared with placebo
Calverley et al, 200724	3-year, randomized, double-blind, placebo-controlled study of inhaled salmeterol (50 µg twice daily) plus inhaled fluticasone propionate (500 µg twice daily), inhaled salmeterol alone, inhaled fluticasone propionate alone, or placebo	The relative risk for exacerbation requiring hospitalization was 0.82 (95% CI, 0.69–0.96) in patients receiving salmeterol alone compared with placebo Addition of fluticasone propionate to salmeterol was not different from salmeterol alone in reducing the risk for exacerbation requiring hospitalization (relative risk 1.02 [95% CI, 0.87–1.20] compared with salmeterol alone)
Puhan et al, 200913	Meta-analysis of randomized trials of ≥4 weeks’ duration to test the effect of inhaled drug regimens on COPD exacerbations	35 studies included 26,786 patients receiving placebo, inhaled long-acting beta-agonists, inhaled long-acting cholinergic antagonists, inhaled corticosteroids, or inhaled combination therapy with long-acting beta-agonists and inhaled corticosteroids All regimens of inhaled therapy were equally effective compared with placebo at reducing the risk for exacerbation
Cost-effectiveness of maintenance therapy of COPD
Rutten-van Mölken, Goossens, 201225	Systematic literature review of economic evaluations of drug therapy for COPD	Tiotropium, a long-acting cholinergic antagonist, reduced COPD-related healthcare costs in most, but not in all studies Long-acting beta-2 agonists combined with inhaled corticosteroids improve outcomes, but with an increase in total COPD-related costs The cost-effectiveness of COPD maintenance therapy is better in patients at high risk for exacerbation

CI indicates confidence interval; COPD, chronic obstructive pulmonary disease.