PAR22: IMPACT OF LEVALBUTEROL VERSUS RACEMIC ALBUTEROL ON OUTPATIENT ASTHMA CARE CHARGES

Abstract

Preliminary evidence suggests that levalbuterol (LEV), the therapeutically active isomer of albuterol, can improve clinical outcomes while reducing health care costs compared to racemic albuterol (RAC). OBJECTIVE: Explore the impact of LEV versus RAC on resource utilization, co-medication use, and cost of therapy in asthmatics. METHODS: Claims data on patients prescribed LEV and RAC were obtained from the PharMetrics Integrated Outcomes Database. Age- and sex-matched samples of patients initiating therapy with LEV or RAC (no prescriptions for either agent in prior 6 months) were selected and their asthma-related charges were assessed over 6 months following the initial prescription. RESULTS: 544 LEV-treated patients were identified and matched to 544 RAC-treated patients. 70% of all patients were <12 years of age. 32% of RAC patients and 59% of LEV patients received asthma controller medication during the prior 6 months. Mean asthma-related (pharmacy and medical) charges during the prior 6 months were $872 versus $587 in the LEV and RAC groups respectively. During the 6 months follow-up period, controller medication use increased among RAC patients to 59%, while use among LEV patients remained unchanged. Overall mean charges decreased by $298 for LEV and $61 for RAC. In patients receiving concomitant controller medications, LEV was associated with a $247 decline in charges versus a $116 increase for RAC. Among patients treated in primary care (pediatricians, family practitioners, and internists), the reduction in mean charges was $262 for LEV, while RAC was associated with a $180 increase. CONCLUSIONS: 1) LEV was prescribed to patients who were “sicker” than those prescribed RAC; 2) Patients treated with RAC, but not LEV, tended to require additional controller medications; 3) LEV was associated with greater reduction in total cost compared to RAC, which in “sicker” and primary care patients was associated with increased cost.