Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study

Briggs, Andrew; Glick, Henry A.; Lozano‐Ortega, Greta; Spencer, Michael D.; Calverley, Peter; Jones, Penelope; Vestbo, Jørgen

doi:10.1183/09031936.00153108

Cited by 59 publications

(64 citation statements)

References 28 publications

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“…57 This is well above the threshold used by the UK National Institute for Clinical Effectiveness (NICE) to assess cost effectiveness (£20-30,000 per QALY 58 ). A secondary economic analysis of the TORCH trial 59 estimated that salmeterol/fluticasone had an overall cost per QALY of $43,600 compared to placebo, SFC had a lower cost effectiveness ratio than either salmeterol or fluticasone alone ($197,000 and $78,000 per QALY respectively), and in this case the economic analysis supports the clinical evidence that combination therapy is the better treatment.…”

Section: Economic Issuessupporting

confidence: 49%

“…Although a model may suggest that a drug is cost effective in a certain health economy it cannot automatically be assumed that it will be cost effective in all health economies. 60 In the secondary economic analysis of the TORCH trial, 59 there were geographical variations in the cost effectiveness of salmeterol/fluticasone, with an estimate of cost per QALY of $24,200 in Western Europe and $77,100 in the USA.…”

Section: Economic Issuesmentioning

confidence: 99%

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Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Halpin

2010

Primary Care Respiratory Journal

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SummaryTranslating the growing evidence base on COPD management into practice can be challenging and understanding the strengths and weakness of published studies is crucial. Studies should conform to the standards of CONSORT statement; they should be sufficiently powered, participants should be randomised, there should be assignment concealment, and the outcome measures and analyses should be decided in advance.The interpretation of the results may be affected by age and severity inclusion criteria for the study and the exclusion of patients with co-morbid illnesses. Whether previous medication is continued or stopped can affect the interpretation of the results. Secondary analyses in sub-groups should be viewed with caution unless pre-specified and accommodated in the trial design and power calculations. Real world observational studies may be confounded by non-randomisation of participants but can sometimes yield valuable insights.The way in which the results are presented can influence their interpretation and their magnitude with respect to minimal important differences as well as statistical significance is important.Research studies help formulate management algorithms but often the questions they address are too specific to allow evidence-based sequencing of therapies.

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Section: Economic Issuessupporting

confidence: 49%

Section: Economic Issuesmentioning

confidence: 99%

Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Halpin

2010

Primary Care Respiratory Journal

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“…Cost effectiveness evaluations for medications in COPD are much more complicated due to the small incremental improvements in outcomes compared with those seen in asthma, so that cost effectiveness is determined by willingness to pay (44,47). Single-entity ICSs are the least cost effective compared with LABAs or ICS/LABA combination, which is mostly attributable to the LABA component (47,48).…”

Section: Cost Effectivenessmentioning

confidence: 99%

Inhaled Corticosteroids in Lung Diseases

Raissy¹,

Kelly²,

Harkins

et al. 2013

Am J Respir Crit Care Med

109

101

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“…In the UK, it is commonly considered that treatments falling below £20,000 per QALY are likely to be considered cost-effective. At a threshold willingness to pay for a QALY of $50,000 (conventional value in the USA), the likelihood for the combination treatment, salmeterol and fluticasone being cost-effective is ,0.93, 0.01 and 0.03, respectively, in the Western European region, suggesting that the combination should be preferred to monotherapies on the grounds of cost-effectiveness [52]. In the OPTIMAL trial, the association of the salmeterol/fluticasone combination with tiotropium improved some health outcomes, including the number of exacerbations requiring hospitalisations versus tiotropium alone, but the incremental cost-effectiveness ratio per QALY (from $145,000 to $243,000) compared with tiotropium alone suggested that monotherapy with tiotropium is the most cost-effective choice [53].…”

Section: Economic Aspects Of Copd Pharmacological Treatmentsmentioning

confidence: 99%

Treatment of COPD: from pharmacological to instrumental therapies

Alifano¹,

Cuvelier²,

Delage³

et al. 2010

European Respiratory Review

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T he two main goals of the current management of chronic obstructive pulmonary disease (COPD) are: 1) to reduce the impact of the disease on daily activities; and 2) to reduce the risk of future events (exacerbations, lung function decline and death) [1]. The first measure is obviously smoking cessation; however, we will not discuss this.Treatment guidelines are mainly based on randomised clinical trials that include a small and highly selected fraction of the COPD population [2]. Therefore, it is questionable as to whether these evidence-based guidelines can be extrapolated to the overall COPD population in the everyday practice. Indeed, less than one in five or 10 patients with COPD could fit into inclusion or exclusion criteria commonly used in clinical trials evaluating efficacy of pharmacological treatments [2,3]. In addition, COPD is a heterogeneous disease and patients with similar forced expiratory volume in 1 s (FEV1) may show very different functional status, underlying lung pathology and comorbidities. For most treatments, differences in the responsiveness of COPD subgroups are not yet established and large, long clinical trials, along with high-quality meta-analyses, remain the basis of the current treatment guidelines and the evaluation of the benefit/risk ratio of the main therapeutic classes used in COPD management. However, even the large therapeutic trials may suffer from methodological limitations in the design or analysis [4].The most important outcomes in clinical trials are patientcentred outcomes. Exacerbations, health-related quality of life and mortality are logical major outcomes in COPD trials [4]. In addition, exercise performance and lung function decline are other important targets for therapeutic intervention in COPD [5]. Lung function and biological markers reliably predicting individual response to treatments would be useful. PHARMACOLOGICAL INTERVENTIONS BronchodilatorsBronchodilators are the mainstay of the current pharmacological management of COPD. Long-acting bronchodilators reduce exacerbations and improve health-related quality of life [6][7][8][9][10][11]. The inconsistencies in the definitions or statistical analyses of exacerbations hamper comparison of efficacy data on this outcome between trials performed with different long-acting bronchodilators [4,12]. A clinical trial has been designed to compare the effect of tiotropium and salmeterol on exacerbations and would require the inclusion of 6,800 patients in order to potentially detect a difference in efficacy between the two long-acting bronchodilators [13]. The reduction of lung function decline by bronchodilators is a matter of debate [11]. A post hoc analysis of the TORCH study suggested that salmeterol reduces the rate of decline in post-bronchodilator FEV1 versus placebo [8]. A post hoc analysis of two 1-yr trials with tiotropium versus placebo also showed an improvement in the rate of decline of FEV1 [14]. Except in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II COPD [10], t...

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Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study

Cited by 59 publications

References 28 publications

Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Inhaled Corticosteroids in Lung Diseases

Treatment of COPD: from pharmacological to instrumental therapies

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