Cost-effectiveness analysis of umeclidinium/vilanterol for the management of patients with moderate to very severe COPD using an economic model

Wilson, Michele; Patel, Jeetvan; Coleman, Amber; McDade, Cheryl; Stanford, Richard H.; Earnshaw, SR

doi:10.2147/copd.s124420

Cited by 22 publications

(40 citation statements)

References 26 publications

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“…However, additional research is needed to confirm this hypothesis. Consistent with the reduction in COPD-related healthcare costs reported here, several other studies support the economic benefit of UMEC/VI treatment initiation when compared with tiotropium monotherapy [ 25 – 28 ], open dual LAMA + LABA treatment [ 28 ], or no long-acting bronchodilator treatment [ 28 ]. However, whether a delay in initiation of UMEC/VI has further cost implications in these scenarios remains to be seen.…”

Section: Discussionsupporting

confidence: 86%

The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models

Buikema

Brekke

Anderson

et al. 2018

Multidiscip Respir Med

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BackgroundChronic obstructive pulmonary disease (COPD) is associated with high clinical and economic burden. Optimal pharmacological therapy for COPD aims to reduce symptoms and the frequency and severity of exacerbations. Umeclidinium/vilanterol (UMEC/VI) is an approved combination therapy for once-daily maintenance treatment of patients with COPD. This study evaluated the impact of delaying UMEC/VI initiation on medical costs and exacerbation risk.MethodsA retrospective analysis of patients with COPD who initiated UMEC/VI between 4/28/2014 and 7/31/2016 was conducted using the Optum Research Database. The index date was the first COPD visit after UMEC/VI available on US formulary (Commercial 4/28/2014; Medicare Advantage 1/1/2015). Patients were followed for 12 months post-index, and categorized into 12 cohorts corresponding to month (30-day period) of UMEC/VI initiation (i.e. Months 1–12) post-index. The outcomes studied during the follow up period included COPD-related and all-cause medical costs, and risk of COPD exacerbations. Marginal structural models (MSM) were used to control for time-varying confounding due to changes in treatment and severity during follow up.Results2,200 patients initiating UMEC/VI were included in the study sample. Patients’ average age was 69.3 years, 49.9% were female and 69.7% were Medicare insured. Following MSM analysis, 12-month adjusted COPD-related medical costs increased by 2.9% (95% confidence interval [CI]: 0.1–5.9%; p = 0.044) for each monthly delay in UMEC/VI initiation, with a 37.4% higher adjusted cost for patients initiating UMEC/VI in Month 12 versus Month 1 ($13,087 vs. $9524). The 12-month adjusted all-cause medical costs increased by 2.8% (95% CI: 0.6–5.2%; p = 0.013) for each monthly delay, with a 36.1% higher adjusted cost for patients initiating UMEC/VI at Month 12 versus Month 1 ($22,766 vs. $16,727). The monthly risk of severe exacerbation was significantly higher in patients who had not yet initiated UMEC/VI than those who had (hazard ratio: 1.74; 95% CI: 1.35–2.23; p < 0.001).ConclusionsPrompt use of UMEC/VI following a physician visit for COPD appears to result in economic and clinical benefits, with reductions in medical costs and exacerbation risk. Additional research is warranted to assess the benefits of initiating UMEC/VI as a first-line therapy compared with escalation to UMEC/VI from monotherapies.Electronic supplementary materialThe online version of this article (10.1186/s40248-018-0151-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 86%

The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models

Buikema

Brekke

Anderson

et al. 2018

Multidiscip Respir Med

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“…This study is the first to compare two LAMA/LABA dual therapies using direct head-to-head data from a randomized, 12-week study [ 24 ], which is the most reliable set of data to include within a cost-effectiveness model [ 24 ]. Other studies have compared LAMA/LABA dual therapy using models with assumptions based on network meta-analyses [ 47 , 48 ], or have used head-to-head data to compare UMEC/VI with TIO monotherapy [ 26 , 49 ]. For example, a UK cost-effectiveness analysis of TIO/OLO found that costs and QALYs associated with TIO/OLO were equal to those of UMEC/VI and IND/GLY.…”

Section: Discussionmentioning

confidence: 99%

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

Driessen

Whalen²,

Buguth³

et al. 2018

Respir Res

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BackgroundA head-to-head study demonstrated the superiority of once-daily umeclidinium bromide/vilanterol (UMEC/VI) 62.5/25 mcg on trough forced expiratory volume in 1 s (FEV1) versus once-daily tiotropium/olodaterol (TIO/OLO) 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated the cost effectiveness of UMEC/VI versus TIO/OLO from a Spanish National Healthcare System perspective, using data from this study and Spanish literature.MethodsThis analysis was conducted from the perspective of the Spanish National Healthcare System with a 3-year horizon as base case. A disease progression model using a linked risk equation approach was used to estimate disease progression and associated healthcare costs, and quality-adjusted life years (QALYs). The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was used to develop the statistical risk equations for clinical endpoints, and costs were calculated using a health state approach (by dyspnea severity). Utilities for QALY calculation were estimated using patient baseline characteristics within a regression fit to Spanish observational data. Treatment effect, expressed as change from baseline in FEV1 was obtained from the head-to-head study and used in the model (UMEC/VI minus TIO/OLO difference: + 52 mL [95% confidence interval: 28, 77]). Baseline patient characteristics were sourced from Spanish literature or the head-to-head study if unavailable. A scenario analysis using only the intent-to-treat (ITT) population from the head-to-head study, and sensitivity analyses (including probabilistic sensitivity analyses), were conducted. Direct healthcare costs (2017 Euro) were obtained from Spanish sources and costs and benefits were discounted at 3% per annum.ResultsUMEC/VI was associated with small improvements in QALYs (+ 0.029) over a 3-year time horizon, compared with TIO/OLO, alongside cost savings of €393/patient. The ITT scenario analysis and sensitivity analyses had similar results. All probabilistic simulations resulted in UMEC/VI being less costly and more effective than TIO/OLO.ConclusionUMEC/VI dominated TIO/OLO (more effective and less expensive). These results may aid payers and decision-makers in Spain when making judgements on which long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) treatments can be considered cost effective in Spain.Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0916-7) contains supplementary material, which is available to authorized users.

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“…These results suggest that umeclidinium/vilanterol treatment would be dominant compared with tiotropium and no long‐acting bronchodilator treatment, and less costly than open‐dual LAMA + LABA treatment in patients with moderate to very severe COPD …”

Section: Clinical Trialsmentioning

confidence: 93%

“…Several studies were reviewed to examine the cost‐effectiveness of umeclidinium/vilanterol (ANORO) compared to both monotherapies and other LABA/LAMA combinations. In one study, umeclidinium/vilanterol (ANORO) treatment for moderate to very severe COPD was associated with lower lifetime medical costs ($82 344) compared with tiotropium ($88 822) open‐dual LAMA + LABA treatment ($114 442), and no long‐acting bronchodilator ($86 751) . Fewer exacerbations were predicted to occur with umeclidinium/vilanterol treatment compared with no long‐acting bronchodilator treatment.…”

Section: Clinical Trialsmentioning

confidence: 99%

Fixed‐dose combination of umeclidinium and vilanterol for patients with chronic obstructive pulmonary disease: A systematic review

Ramadan

Masri²,

Rizk³

2019

Clinical Respiratory J

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Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that is predicted to be one of the leading causes of death worldwide. Pharmacologic treatment options of COPD are bronchodilators, using either long‐acting β2‐agonists (LABAs), or long‐acting muscarinic antagonists (LAMAs), or a combination of two. Anoro Ellipta (umeclidinium + vilanterol) dry powder inhaler, a fixed‐dose combination of LAMA and LABA, was Food and Drug Administration (FDA) approved in 2013 for COPD. The objective of this study is to evaluate the efficacy and safety of once daily umeclidinium/vilanterol (62.5 mcg/25 mcg) in COPD patients, focusing on pharmacodynamic and pharmacokinetic characteristics, efficacy and safety in clinical studies and cost. Literature search was done through PubMed (2004‐2017) using the terms umeclidinium, vilanterol, COPD, LABA and LAMA. Recent and significant clinical trials about the monocomponents and their combination were identified, in addition to reviews, guidelines for COPD, data from manufacturer and FDA product labels. The search was limited to English language studies on human subjects. Clinical data published on the combination of umeclidinium/vilanterol in patients with COPD have shown greater improvements in lung function compared to monotherapies. However, further studies comparing umeclidinium/vilanterol FDC (ANORO) to other LABA/LAMA combinations are needed.

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Cost-effectiveness analysis of umeclidinium/vilanterol for the management of patients with moderate to very severe COPD using an economic model

Cited by 22 publications

References 26 publications

The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models

The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: an observational administrative claims database analysis using marginal structural models

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

Fixed‐dose combination of umeclidinium and vilanterol for patients with chronic obstructive pulmonary disease: A systematic review

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