The Impact of Nebulized Levalbuterol on Health Care Payments for Elderly Asthma and Chronic Obstructive Pulmonary Disease Patients in Medicaid Plans

Objective: To compare health expenditures among elderly Medicaid patients with asthma or chronic obstructive pulmonary disease (COPD) who used either nebulized levalbuterol (levosalbutamol) or racemic albuterol (salbutamol) for bronchodilation. Methods: A retrospective, quasi-experimental study was conducted. Trends over time in total medical expenditures and disease-specific expenditures were compared for levalbuterol versus racemic albuterol patients. Differences in these trends were estimated by conducting generalized estimating equation regression analyses of difference-in-difference regression models. Prior to comparing levalbuterol and racemic albuterol users, these models controlled for their differences in demographics, reason for Medicaid eligibility, location, health-plan type, co-morbidities, severity of asthma or COPD, the use of other medications, and the receipt of influenza or pneumonia inoculations. Several sensitivity analyses were also conducted to estimate the reliability of the results, as related to inclusion criteria (e.g. days of therapy), regression methods, or to conduct separate analyses for asthma and COPD patients. Results: When asthma and COPD patients were pooled, every analysis of total healthcare expenditures showed large, statistically significant savings associated with levalbuterol use. These savings ranged from $US1167 to $US1792 per patient over a 6-month period, depending on inclusion criteria or statistical methods. When the analyses were separated by disease, a focus on total health expenditures still favored levalbuterol and the savings associated with levalbuterol use were about twice as high per patient for COPD patients ($US2490) as they were for asthma patients ($US1122). A focus on disease-related expenditures showed a statistically significant loss of approximately $US853 per patient for levalbuterol users who had asthma (p = 0.0031) but a statistically significant saving of approximately $US967 for COPD patients who used levalbuterol (p = 0.0031). Conclusions: A focus on total medical expenditures showed that the added costs of using levalbuterol were more than offset by reductions in other types of healthcare expenditures. Savings were higher for COPD patients than for asthma patients. A focus on disease-related expenditures showed savings for COPD patients who used levalbuterol, but results for asthma patients favored racemic albuterol.