Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

Mölken, Maureen P.M.H. Rutten-van; Goossens, Lucas

doi:10.2165/11589270-000000000-00000

Cited by 32 publications

(59 citation statements)

References 76 publications

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“…However, as some costs and effects resulting from the intervention are expected to occur after this period, a Markov model was constructed to be able to capture long-term costs and effects of the PHARMACOP-intervention. Markov models have often been used in health economic evaluations of COPD interventions [17,18] and are a recommended approach to increase external validity and to allow for long-term follow-up [19,20]. Details of the model are described in the following part.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, a percentage of utility decrement from baseline was modeled if an exacerbation occurred (Table 1). Notably, the PHARMACOP-intervention showed no significant effects on quality of life as measured by the EQ-5D, a result that might be related to the timing of the pre-scheduled pharmacy-visits for measurement of health status and the relatively short duration of exacerbations [20]. Therefore, as an conservative approach, no direct effects on quality of life were applied in the intervention group and utility values were solely based on disease state and the occurrence of exacerbations.…”

Section: Methodsmentioning

confidence: 99%

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Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

Boven¹,

Tommelein²,

Boussery³

et al. 2014

Respiratory Research

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BackgroundThe PHARMACOP-intervention significantly improved medication adherence and inhalation technique for patients with COPD compared with usual care. This study aimed to evaluate its cost-effectiveness.MethodsAn economic analysis was performed from the Belgian healthcare payer’s perspective. A Markov model was constructed in which a representative group of patients with COPD (mean age of 70 years, 66% male, 43% current smokers and mean Forced Expiratory Volume in 1 second of % predicted of 50), was followed for either receiving the 3-month PHARMACOP-intervention or usual care. Three types of costs were calculated: intervention costs, medication costs and exacerbation costs. Outcome measures included the number of hospital-treated exacerbations, cost per prevented hospital-treated exacerbation and cost per Quality Adjusted Life-Year. Follow-up was 1 year in the basecase analysis. Sensitivity and scenario analyses (including long-term follow-up) were performed to assess uncertainty.ResultsIn the basecase analysis, the average overall costs per patient for the PHARMACOP-intervention and usual care were €2,221 and €2,448, respectively within the 1-year time horizon. This reflects cost savings of €227 for the PHARMACOP-intervention. The PHARMACOP-intervention resulted in the prevention of 0.07 hospital-treated exacerbations per patient (0.177 for PHARMACOP versus 0.244 for usual care). Results showed robust cost-savings in various sensitivity analyses.ConclusionsOptimization of current pharmacotherapy (e.g. close monitoring of inhalation technique and medication adherence) has been shown to be cost-saving and should be considered before adding new therapies.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

Boven¹,

Tommelein²,

Boussery³

et al. 2014

Respiratory Research

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“…Most information available focuses on the cost-effectiveness of tiotropium and salmeterol versus short-acting bronchodilators or placebo. Estimates of the costeffectiveness of tiotropium versus short-acting bronchodilators or placebo ranged from cost saving to $2,341 per exacerbation avoided or $26,094 per QALY gained [9]. Estimates of the costeffectiveness of salmeterol versus short-acting bronchodilators or placebo ranged from cost savings of $10,152 per exacerbation avoided or $197,000 per QALY gained [9].…”

Section: Discussionmentioning

confidence: 99%

“…Estimates of the costeffectiveness of tiotropium versus short-acting bronchodilators or placebo ranged from cost saving to $2,341 per exacerbation avoided or $26,094 per QALY gained [9]. Estimates of the costeffectiveness of salmeterol versus short-acting bronchodilators or placebo ranged from cost savings of $10,152 per exacerbation avoided or $197,000 per QALY gained [9]. Six modelling studies investigated the cost-effectiveness of tiotropium versus salmeterol [12,13,[31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of tiotropiumversussalmeterol: the POET-COPD trial

Hoogendoorn

Al²,

Beeh

et al. 2012

Eur Respir J

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The aim of this study was to perform a 1-yr trial-based cost-effectiveness analysis (CEA) of tiotropium versus salmeterol followed by a 5-yr model-based CEA.The within-trial CEA, including 7,250 patients with moderate to very severe chronic obstructive pulmonary disease (COPD), was performed alongside the 1-yr international randomised controlled Prevention of Exacerbations with Tiotropium (POET)-COPD trial comparing tiotropium with salmeterol regarding the effect on exacerbations. Main end-points of the trial-based analysis were costs, number of exacerbations and exacerbation days. The model-based analysis was conducted to extrapolate results to 5 yrs and to calculate quality-adjusted life years (QALYs).1-yr costs per patient from the German statutory health insurance (SHI) perspective and the societal perspective were J126 (95% uncertainty interval (UI) J55-195) and J170 (95% UI J77-260) higher for tiotropium, respectively. The annual number of exacerbations was 0.064 (95% UI 0.010-0.118) lower for tiotropium, leading to a reduction in exacerbation-related costs of J87 (95% UI J19-157). The incremental cost-effectiveness ratio was J1,961 per exacerbation avoided from the SHI perspective and J2,647 from the societal perspective. In the model-based analyses, the 5-yr costs per QALY were J3,488 from the SHI perspective and J8,141 from the societal perspective.Tiotropium reduced exacerbations and exacerbation-related costs, but increased total costs. Tiotropium can be considered cost-effective as the resulting cost-effectiveness ratios were below commonly accepted willingness-to-pay thresholds.KEYWORDS: Chronic obstructive pulmonary disease, costs, exacerbations, model, qualityadjusted life year, trial T he current international guidelines for the treatment of chronic obstructive pulmonary disease (COPD) recommend regular treatment with a long-acting anticholinergic drug (tiotropium) or a long-acting b-agonist (salmeterol, formoterol or indacaterol) for patients with moderate to very severe COPD [1]. These bronchodilators have been shown to improve symptoms, health-related quality of life and lung function, and reduce exacerbations and hospitalisations [2][3][4]. However, guidelines do not give a preference for either drug class. Until the publication of the Prevention of Exacerbations with Tiotropium (POET)-COPD trial, head-to-head comparisons were limited, had a short duration and/or were underpowered to detect a difference in COPD exacerbations [5,6]. The 1-yr POET-COPD trial was designed to compare the effects of tiotropium 18 mg once daily or salmeterol 50 mg twice daily on the occurrence of moderate or severe exacerbations in patients with moderate to very severe COPD and a history of least one exacerbation in the previous year [7]. This clinical trial demonstrated that tiotropium prolonged the time to first exacerbation (hazard ratio (HR) 0.83, 95% CI 0.77-0.90) and the time to first exacerbation leading to hospitalisation (HR 0.72, 95% CI 0.61-0.85), and reduced the total number of exacerbations (...

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QVA149 (Indacaterol/Glycopyrronium Fixed-Dose Combination): A Review of Its Use in Patients with Chronic Obstructive Pulmonary Disease

Frampton

2014

Drugs

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QVA149 (indacaterol/glycopyrronium) [Xoterna(®) Breezhaler(®), Ultibro(®) Breezhaler(®)] is an inhaled fixed-dose combination of indacaterol (a long-acting selective β2-adrenergic receptor agonist [LABA]) and glycopyrronium (a long-acting muscarinic receptor antagonist [LAMA]) that has been approved in the EU and Japan for the symptomatic control of chronic obstructive pulmonary disease (COPD) in adults. In phase III studies, QVA149 significantly improved bronchodilation versus indacaterol, glycopyrronium or tiotropium alone and the LABA/inhaled corticosteroid fixed-dose combination salmeterol/fluticasone. These improvements in lung function, which were rapid in onset and maintained during long-term treatment, were generally associated with significant improvements in dyspnoea, health status, COPD exacerbation risk, patient symptoms, and rescue medication use. The SHINE and ILLUMINATE studies in low (exacerbation) risk patients with moderate to severe disease suggest that QVA149 may offer more symptomatic relief than tiotropium and salmeterol/fluticasone. Similarly, the SPARK study in high (exacerbation) risk patients with severe or very severe disease showed that QVA149 was more effective than glycopyrronium in preventing moderate to severe exacerbations, and suggests that QVA149 may offer more symptomatic relief than LAMA monotherapy. Another phase III study comparing QVA149 with salmeterol/fluticasone in high-risk patients with moderate to very severe disease (FLAME) is ongoing. QVA149 is generally well tolerated, with no new safety signals identified compared with its monocomponents. Bronchodilators remain central to the symptomatic management of COPD. When dual bronchodilation is indicated, QVA149 offers the convenience of two bronchodilators in a single inhaler coupled with a simple, once-daily dosing regimen that may encourage better treatment adherence. Therefore, it is a valuable option in the treatment of COPD.

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Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

Abstract: The currently available economic evaluations indicate differences in cost effectiveness between COPD maintenance therapies, but for a more meaningful comparison of results it is important to improve the consistency with respect to study methodology and choice of comparator.

Cited by 32 publications

References 76 publications

Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

Improving inhaler adherence in patients with Chronic Obstructive Pulmonary Disease: a cost-effectiveness analysis

Cost-effectiveness of tiotropiumversussalmeterol: the POET-COPD trial

QVA149 (Indacaterol/Glycopyrronium Fixed-Dose Combination): A Review of Its Use in Patients with Chronic Obstructive Pulmonary Disease

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