Cost-utility analysis of indacaterol in Germany: A once-daily maintenance bronchodilator for patients with COPD

Price, David; Gray, Alastair; Gale, Rupert; Asukai, Yumi; Mungapen, Laura; Lloyd, Adam; Peters, Lars; Neidhardt, K; Gantner, Tobias

doi:10.1016/j.rmed.2011.06.005

Cited by 32 publications

(37 citation statements)

References 22 publications

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“…There were 16 cost-effectiveness studies that used empirical analysis of clinical trial data of individual patients, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] 14 studies that used Markov modelling, [44][45][46][47][48][49][50][51][52][53][54][55][56][57] and eight that used empirical analysis based on observational data. [58][59][60][61][62][63][64][65] Two studies have used a different approach, such as extrapolating the resource use reduction that was obtained after meta-analyses of clinical trials.…”

Section: Methods Usedmentioning

confidence: 99%

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Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

Mölken

Goossens

2012

PharmacoEconomics

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Section: Methods Usedmentioning

confidence: 99%

“…[57] It was based on a Markov study with four COPD states (mild, moderate, severe and very severe) and death. This study compared indacaterol 150 mg with tiotropium and salmeterol and reported better health outcomes and lower total costs for indacaterol.…”

Section: Indacaterolmentioning

confidence: 99%

Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

Mölken

Goossens

2012

PharmacoEconomics

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“…Tiotropium3. Salmeterol150 µg1 vs. 2: –£248 (–€286)1 vs. 3: –£110 (–€127)300 µg1 vs. 2: –£259 (–€299)(2011)150 µg1 vs. 2: +0.008 QALYs1 vs. 3: +0.008 QALYs300 µg1 vs. 2: +0.011 QALYs150 µg vs. 2/3: Dominant300 µg vs. 2: DominantIndacaterol dominates100Price et al 2011 (Germany) [20]Markov model (CUA)3 yearNovartis1. Indacaterol (150 and 300 µg)2.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Quality Appraisal of Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Recommendations

et al. 2016

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BackgroundWorldwide, chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung disease with considerable clinical and socioeconomic impact. Pharmacologic maintenance drugs (such as bronchodilators and inhaled corticosteroids) play an important role in the treatment of COPD. The cost effectiveness of these treatments has been frequently assessed, but studies to date have largely neglected the impact of treatment sequence and the exact stage of disease in which the drugs are used in real life.ObjectiveWe aimed to systematically review recently published articles that reported the cost effectiveness of COPD maintenance treatments, with a focus on key findings, quality and methodological issues.MethodsWe performed a systematic literature search in Embase, PubMed, the UK NHS Economic Evaluation Database (NHS-EED) and EURONHEED (European Network of Health Economics Evaluation Databases) and included all relevant articles published between 2011 and 2015 in either Dutch, English or German. Main study characteristics, methods and outcomes were extracted and critically assessed. The Quality of Health Economic Studies (QHES) instrument was used as basis for quality assessment, but additional items were also addressed.ResultsThe search identified 18 recent pharmacoeconomic analyses of COPD maintenance treatments. Papers reported the cost effectiveness of long-acting muscarinic antagonist (LAMA) monotherapy (n = 6), phosphodiesterase (PDE)-4 inhibitors (n = 4), long-acting beta agonist/inhaled corticosteroid (LABA/ICS) combinations (n = 4), LABA monotherapy (n = 2) and LABA/LAMA combinations (n = 2). All but two studies were funded by the manufacturer, and all studies indicated favourable cost effectiveness; however, the number of quality-adjusted life-years (QALYs) gained was small. Less than half of the studies reported a COPD-specific outcome in addition to a generic outcome (mostly QALYs). Exacerbation and mortality rates were found to be the main drivers of cost effectiveness. According to the QHES, the quality of the studies was generally sufficient, but additional assessment revealed that most studies poorly represented the cost effectiveness of real-life medication use.ConclusionsThe majority of studies showed that pharmacologic COPD maintenance treatment is cost effective, but most studies poorly reflected real-life drug use. Consistent and COPD-specific methodology is recommended.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0448-2) contains supplementary material, which is available to authorized users.

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“…There are no studies on the comparison with formoterol. The only study (model-based) on the comparison with indacaterol found indacaterol to be dominant [35]. However, caution is needed when interpreting this finding, as the model input data relied solely on one clinical study in which tiotropium was administered on an open-label basis.…”

Section: Discussionmentioning

confidence: 99%

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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Cost-utility analysis of indacaterol in Germany: A once-daily maintenance bronchodilator for patients with COPD

Abstract: Indacaterol is cost-effective compared to tiotropium and salmeterol.

Cited by 32 publications

References 22 publications

Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

Systematic Review and Quality Appraisal of Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Recommendations

Cost-effectiveness of tiotropiumversussalmeterol: the POET-COPD trial

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