Economic analyses comparing tiotropium with ipratropium or salmeterol in UK patients with COPD

Abstract

Aims: This study presents a cost-effectiveness and budget impact analysis comparing cost and outcomes for UK patients with COPD treated with either tiotropium, ipratropium or salmeterol.Methods: A previously-published COPD cost-effectiveness model was adapted for the UK, then used to estimate the cost-effectiveness of tiotropium compared to salmeterol and ipratropium. Additional epidemiological data were used to estimate the budget impact of switching patients from ipratropium or salmeterol to tiotropium.Results: In England, the estimated annual cost per patient on tiotropium was £1350, on salmeterol was £1404, and on ipratropium was £1427; in Scotland/Wales/Northern Ireland (S/W/NI) these costs were £1439, £1565, and £1631, respectively. Tiotropium patients experienced better quality-adjusted life-years (QALYs) across all comparisons, and this option was therefore dominant compared to salmeterol and ipratropium. The probability of tiotropium being dominant ranged from 72% to 87% across comparisons. At a willingnessto-pay threshold of £20,000 per QALY, tiotropium had at least a 97% chance of being cost-effective. The estimated annual saving per primary care trust (PCT) of switching patients from salmeterol and ipratropium to tiotropium in England was £230,000 and in S/W/NI was £160,000.Conclusions: Tiotropium is a cost-effective alternative to ipratropium and salmeterol, and switching COPD patients from ipratropium and salmeterol to tiotropium could result in considerable cost savings for PCTs along with improvements in quality-of-life.

Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

“…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.…”

“…[45,48,49,61] We discuss these studies together, because, irrespective of how the comparator is labelled, the comparator is in fact short-acting bronchodilator therapy, either used as needed or on a regular basis. All except three studies concluded that salmeterol improved health outcomes at the expense of a cost increase.…”

Cost-effectiveness of tiotropiumversussalmeterol: the POET-COPD trial

“…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]. Four studies found that tiotropium was cost saving in comparison with salmeterol in the Netherlands, Greece, Switzerland and the UK [12,31,32,34].…”

“…Six modelling studies investigated the cost-effectiveness of tiotropium versus salmeterol [12,13,[31][32][33][34]. Four studies found that tiotropium was cost saving in comparison with salmeterol in the Netherlands, Greece, Switzerland and the UK [12,31,32,34]. A study from NAIK et al [33] found the cost-effectiveness ratio to be $1,817 per exacerbation avoided in USA.…”

Role of tiotropium in chronic obstructive pulmonary disease exacerbation

“…chronic and progressive dyspnoea, cough and sputum production, which result in significant impairment in exercise capacity and quality of life. 2 Worsening lungs function is also associated with frequently increasing disease severity. 3 This contributes to a more rapid decline in lungs function, 4 increased mortality and further reductions in quality of life.…”