Characteristics of Medicare and Medicaid Patients Initiating Volara Respiratory Therapy: A Medical Claims Study

Volara is a novel respiratory device that delivers oscillation, lung expansion, and aerosolized medication. This study explores healthcare resource utilization (HCRU) and costs among Medicare and Medicaid enrollees who initiated Volara, providing the first real-world characterization of their HCRU patterns. We conducted a descriptive study using administrative claims data to identify Medicare and Medicaid enrollees who initiated Volara. Respiratory-related HCRU, including emergency department (ED) visits and hospitalizations, and associated costs were summarized for the 12-month pre-initiation and 12-month post-initiation periods as annualized rates and per-member-per-month (PMPM) costs. Analyses were stratified by disease segment based on principal diagnosis as of initiation and patient characteristics, including clinical risk, social risk, and age. No formal statistical comparisons between periods were conducted because of small samples and the exploratory nature of the analysis. Among Medicare enrollees, ED visit rates and costs for respiratory exacerbations were 58% and 39% lower, respectively, in the post-initiation period compared with the pre-initiation period (26.3 vs 11.0 visits per 100 patients; $21 vs $12 PMPM). Hospitalization rates and costs were also lower post-initiation (41.2 vs 30.4 per 100 patients, 26% lower; $512 vs $456 PMPM, 11% lower). ED visits and costs were lower across subgroups, whereas differences in hospitalization rates were more pronounced among patients with higher clinical risk, higher social risk, and older age. Among Medicaid enrollees, ED utilization patterns were mixed, with similar rates but higher costs post-initiation (31.4 vs 29.6 per 100 patients, 5% lower; $135 vs $168 PMPM, 24% higher). In contrast, hospitalization rates and costs were lower post-initiation overall, though subgroup patterns were heterogeneous. These findings provide an initial characterization of real-world utilization and cost patterns among Volara users. Observed patterns varied across populations and subgroups, underscoring the need for further research using comparative designs and appropriate adjustment for confounding to understand these relationships. Respiratory conditions such as chronic obstructive pulmonary disorder or bronchiectasis can lead to exacerbations that result in emergency department visits and hospital stays. These events place a burden on patients and increase healthcare costs. The Volara device combines three respiratory therapies into one and is designed for ease-of-use outside of hospital settings. However, there is limited data on how Volara use impacts healthcare utilization and costs. In this study, we used claims data to identify people covered by Medicare and Medicaid who started using Volara. We examined their emergency department visits, hospitalizations, and related costs in the 12 months before and after they began using the device. Among people in Medicare, emergency department visits and hospital stays for respiratory problems were lower in the period after starting Volara. Associated monthly costs were also lower, especially for hospital stays. Among people with Medicaid, the patterns were less consistent. Emergency department visits were similar before and after starting the device, while hospital stays and related costs were generally lower after initiation. We also found that results varied across patient groups. Among people in Medicare, differences were more pronounced in older patients and those with higher clinical or social risk. This suggests that Volara may have different effects depending on patient characteristics. Because this study was descriptive, did not include a comparison group, and did not account for patient behavior, we cannot determine whether these patterns were caused by the device. Future research using more advanced study designs is needed to better understand the findings.