Cost-Effectiveness Analysis Of Tiotropium Bromide For Patients With Severe Obstructive Pulmonary Disease In Mexico

Abstract

Objectives: Assess the cost-effectiveness of tiotropium bromide for severe obstructive pulmonary disease (COPD) versus indacaterol in Mexican institutions. MethOds: Cost-effectiveness analysis using a decision tree model to assess the risk of exacerbations considering the use of either tiotropium or indacaterol. A Delphi Panel with several expert pulmonologists was performed in order to calculate the cost of medical resources used by EPOC patients, especially when suffering from exacerbations. All results are presented in 2015 Mexican Pesos. A probabilistic sensitivity analysis was conducted on number of exacerbations. Hospitalizations due to exacerbations were considered when a patient suffered from 3 or more events reported on the INVIGORATE study and simulated with a Beta distribution. Results: Assuming that every time a patient suffers an exacerbation his condition worsens, the next exacerbation will require more medical attention.. We consider a cohort of 1,000 patients, a time horizon of 52 weeks and adjusted according to the INVIGORATE study. We observed that 35% of tiotropium patients had at least one exacerbation compared to 40% of the indacaterol patients.. Average cost for tiotropium patients was $55,337,159 MXP and $81,029,630 MXP for indacaterol patients. A 32% increment on treatment cost for the indacaterol patients vs. the tiotropium subjects. cOnclusiOns: Using the results of the Invigorate study the use of tiotropium in COPD treatment from the perspective of the public health system in Mexico represents a potential cost-saving alternative vs. indacaterol. Because tiotropium reduces the number of exacerbations patients might suffer, then there is decreased economic impact with the use of tiotropium.Objectives: Asthma is a progressive inflammatory disease that affects greatly patients' quality of life and demands for aggressive management early on during the course of the disease. The emergence of humanized antibody has equipped pulmonologists with evolutionary treatment tools but it has also influenced the costs of the disease, thus highlighting the necessity of cost-effectiveness data. The purpose of this study was to conduct a systematic review of cost-effectiveness data for omalizumab in the treatment of severe persistent allergic asthma. MethOds: We searched Medline, Embase and Cochrane from inception to the end of December 2016 for cost-effectiveness data for omalizumab in the treatment of severe persistent allergic asthma. An initial search using the keywords "omalizumab, cost effectiveness, and severe asthma" was followed by a search of related citations. References of the included studies were screened for additional studies. Two reviewers independently searched and extracted data with differences adjudicated via consensus discussion. Results: A total 612 studies were identified and six met the inclusion criteria. The majority of rejected studies were due to lack of cost data, failure to include omalizumab as an intervention or comparator, and failure to include severe persistent allergic ...