Development of an Economic Model to Assess the Cost Effectiveness of Treatment Interventions for Chronic Obstructive Pulmonary Disease

Abstract

This Markov model allows, for the first time, a means of estimating the long-term cost effectiveness and cost utility of interventions for COPD. Initial evidence suggests that for patients with poorly reversible COPD and a documented history of frequent COPD exacerbations, the addition of salmeterol (a long-acting beta(2)-agonist) to fluticasone propionate (an inhaled corticosteroid) is potentially cost effective from the Canadian healthcare payer's perspective. However, the precision of this estimate will be improved when additional data are available from clinical trials such as the ongoing TORCH (TOwards a Revolution in COPD Health) study.

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.…”

A randomised controlled trial to assess the clinical effectiveness and cost-effectiveness of alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN)

“…Similar profiles have been used previously to model recovery from acute hepatitis 70 and chronic obstructive pulmonary disease exacerbations. 71 We used linear profiles to simplify subsequent calculations and because models with quadratic terms did not fit as well. As post-SAE utility measurements were taken, on average, 56 (range 0-182) days after a SAE, we used mixed models to estimate the rate at which utility rose after each type of SAE (see Appendix 4).…”

“…We are not aware of any previous studies making such additional measurements, which introduce unique challenges into the estimation of QALYs, although some papers have explicitly modelled the profile of changes after specific events (e.g. hepatitis 70 or chronic obstructive pulmonary disease exacerbations 71 ).…”

What is the clinical effectiveness and cost-effectiveness of cytisine compared with varenicline for smoking cessation? A systematic review and economic evaluation

“…The average ages of the samples from which utility values were drawn were 62 years, 49 years and 65 years for lung cancer, asthma exacerbations and a second non-fatal stroke respectively. The mean ages of the population for which the utilities were provided for a first non-fatal stroke event, 108 COPD 109 and following any CHD event 110 were not reported. For these disease states, an average age of 60 years is assumed with the sensitivity of the results to this assumption is explored by altering baseline utility estimates for these diseases to correspond to ages 50 and 70 years respectively.…”