Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis

Abstract

PurposeFrequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting.Patients and methodsA Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis.ResultsBased on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness.ConclusionThe treatment algorithm recommended in UK clinical practice represents a costeffective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy.

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

“…The model was developed subsequent to a review of published Markov decision models [138][139][140][141][142][143][144][145][146][147] in stable and post-admission COPD populations, and considers stable and post-admission populations separately. The model incorporated both the short-term increased risk of readmission and subsequent mortality after a hospital admission, and the long-term natural history of the disease, taking into account exacerbations, increasing COPD severity and mortality ( Figure 16).…”

“…[138][139][140]143,147 It was assumed that there was a loss of utility for 1 month for moderate exacerbations and a utility loss for 3 months with an improvement after 1 month for severe exacerbations as a result of full recovery taking a longer period of time. 13,155 The utility loss estimate of 15% for moderate exacerbation and 50% in the first month for severe exacerbation was obtained from Rutten-van Molken et al, 139 reducing to 25% in the second and third months for a severe exacerbation.…”

“…13,155 The utility loss estimate of 15% for moderate exacerbation and 50% in the first month for severe exacerbation was obtained from Rutten-van Molken et al, 139 reducing to 25% in the second and third months for a severe exacerbation. 31 An alternative assumption, obtained from Hertel et al 140 was applied in a one-way sensitivity analysis. This assumed a loss of utility for 1 month: mean utility loss of 0.12 for a moderate exacerbation and a utility loss of 0.54 for a severe exacerbation for 1 month.…”

“…160 This assumption was based on vaccination rates of 50% and between 80% and 93% reported in Spanish and UK studies. 161,162 The average number of days and cost of home oxygen therapy received in each severity group was derived from expert opinion reported in Hertel et al (2012). 140 Smoking-cessation advice and pulmonary rehabilitation are also recommended by NICE as usual care for COPD patients.…”

Costs of the Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in a University Hospital

“…Acute exacerbations of COPD, which cause an increase or change in regular therapies and generally require hospitalization, account for a major part of COPD-related health costs (85%) (10,11) and are an important cause of COPD-induced mortality (12). In this study, which aimed to determine the cost for patients with COPD exacerbation in a university hospital, the total cost per patient was 1,064.0 (726.0-1,866.0) TL.…”