Cost-Effectiveness Analysis Of Two Long-Acting Muscarinic Antagonists For Copd Treatment In Spain: Umeclidinium VS. Tiotropium (HO-17-18472)

Abstract

analysis was based on a head-to-head trial comparing changes from baseline in lung function (FEV1) between umeclidinium 62.5mcg and tiotropium 18mcg, on a 12-week-period (Feldman G. et al. Int J Chron Obstruct Pulmon Dis 2016). A previously published linked equations cohort model, based on ECLIPSE and TORCH studies, which estimates COPD progression, exacerbation rates, associated healthcare-costs, quality-adjusted-life-years (QALYs) and survival, was used (Miravitlles M. et al. Int J Chron Obstruct Pulmon Dis 2016). A 3-year time horizon was selected. COPD diagnosed patients with post-bronchodilator FEV1 of 30%-70% predicted and respiratory symptoms (mMRC dyspnoea scale ≥ 2) were included. Differential treatment effect was maintained until first year of analysis, based on a 52-weeks umeclidinium trial; subsequently no differences were assumed. Effectiveness was measured in QALYs, deriving utilities from a Spanish observational study. Directcosts were obtained from local sources and treatments-costs from Spain retail prices for 2017 (€ 45.27 and € 49.06 for umeclidinium and tiotropium respectively). Results were expressed as incremental costs per QALY gained (ICER), applying a 3% discount to costs and QALYs. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed. On DSA different discounts for tiotropium retail price were tested. Results: At base-case umeclidinium was dominant over tiotropium, gaining 0.0135 QALYs with cost-savings of € 192.20. DSA for tiotropium price showed that umeclidinium was cost-effective up to 36.3% tiotropium discount, as ICERs were below the accepted € 30,000/QALY willingness-to-pay threshold in Spain. Varying main parameters in PSA did not have a significant impact on results. ConClusions: From the Spanish NHS perspective, umeclidinium is a dominant alternative to tiotropium, the standard of care for COPD. PRS40 CoSt-EffECtivEnESS AnAlySiS of Adding nEw dRug thiozonidE to iv-th dRug REgimEnS foR multidRug-RESiStAnt tubERCuloSiS

Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective

“…Several cost-effectiveness analyses have been conducted from a Spanish National Healthcare System perspective, using direct head-to-head data. One study compared UMEC and TIO [ 50 ], using direct head-to-head data from a 12-week study whereby in which UMEC was found to be superior to TIO for trough FEV 1 in the ITT population (treatment difference: 53 mL, 95% CI: 25, 81 mL; p < 0.001) [ 24 ]. Results from this cost-effectiveness analysis using direct head-to-head data from the UMEC and TIO study showed results comparable to our study, whereby UMEC dominated TIO, gaining similar 0.014 QALYs and demonstrating cost savings of €192 [ 50 ].…”

“…One study compared UMEC and TIO [ 50 ], using direct head-to-head data from a 12-week study whereby in which UMEC was found to be superior to TIO for trough FEV 1 in the ITT population (treatment difference: 53 mL, 95% CI: 25, 81 mL; p < 0.001) [ 24 ]. Results from this cost-effectiveness analysis using direct head-to-head data from the UMEC and TIO study showed results comparable to our study, whereby UMEC dominated TIO, gaining similar 0.014 QALYs and demonstrating cost savings of €192 [ 50 ]. Another Spanish cost-effectiveness analysis of UMEC/VI versus TIO alone estimated 3-year costs of €6215 and QALYs of 2.025 for patients treated with UMEC/VI and found UMEC/VI to be more effective and costlier than TIO monotherapy, with an incremental cost-effectiveness ratio (ICER) of €21,475/QALY [ 26 ].…”