# Quantifying the Length of Stay and Economic Impact of Albuterol and Levalbuterol in Hospitalized Patients With Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study

## TL;DR

This study found that levalbuterol may reduce hospital stays and costs for COPD patients compared to albuterol.

## Contribution

The study provides new evidence comparing albuterol and levalbuterol's economic and clinical impacts in hospitalized COPD patients.

## Key findings

- Levalbuterol-treated patients had shorter median length of stay (7.0 days vs. 8.0 days) compared to albuterol.
- Levalbuterol was associated with lower median direct healthcare costs (¥8,868.3 vs. ¥10,290.7) compared to albuterol.
- Older patients (aged 60 or older) had longer hospital stays and higher costs regardless of treatment.

## Abstract

Introduction

Chronic obstructive pulmonary disease (COPD) affects millions in China and imposes a considerable economic burden on hospitalized patients who experience exacerbations. Nebulized short-acting beta-2 agonists (SABA) are recommended as initial therapy for exacerbation patients, but the optimal SABA remains uncertain. This study aimed to evaluate the impact of different SABAs, such as albuterol and levalbuterol, on the length of stay (LOS) and direct medical costs among hospitalized patients diagnosed with COPD.

Methods

This retrospective cohort study uses linked hospital administrative data from three hospitals in Chongqing. Patients with COPD, aged 40 years and older, who had been continuously treated with nebulized albuterol or levalbuterol during hospitalization, were eligible for the study. Patients were matched 1:1 by sex, age, and severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4. Patients were grouped according to the different SABA treatments they received. Demographic, economic, and clinical data were retrieved. LOS and direct healthcare costs were assessed.

Results

A total of 158 COPD patients were included, with 79 in each treatment group. Patients treated with levalbuterol had a significantly shorter median LOS (7.0 days vs. 8.0 days, P=0.003) and fewer direct healthcare median costs (total cost: ¥8,868.3 vs. ¥10,290.7, P=0.014; COPD-related western medicine fees: ¥383.8 vs. ¥505.3). Patients aged 60 or older were more likely to experience longer LOS and higher direct costs.

Conclusion

This retrospective cohort analysis supports that albuterol was associated with longer LOS and higher costs than levalbuterol.