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

Abstract

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.

Does pulmonary rehabilitation alleviate depression in older patients with chronic obstructive pulmonary disease

“…Combining pharmacologic therapy with other interventions enhances the effectiveness of management of COPD. Such intervention includes smoking cessation, physical exercise, vaccination, oxygen therapy, and pulmonary rehabilitation 9,10…”

<p>Modelling the Cost-Effectiveness of Indacaterol/Glycopyrronium versus Salmeterol/Fluticasone Using a Novel Markov Exacerbation-Based Approach</p>

“…24 In addition, given the highly controlled nature of clinical trials, the present analysis may not take into account realworld factors that influence outcomes in COPD, such as inhaler technique or treatment adherence. 46,47 These are common limitations of cost-effectiveness analyses in COPD that use clinical trial data, 17,18,20,47 and more generally of the clinical trials themselves. 46 Finally, after the availability of data from clinical trials involving fixed-dose combinations of LABA/LAMA/ICS, 48,49 future costeffective studies of LABA/LAMA may consider these as comparative pharmacologic intervention.…”

Doxycycline Added to Prednisolone in Outpatient-Treated Acute Exacerbations of COPD: A Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial

“…Also, missing data were imputed using multiple imputation by chained equations, which is generally considered the most valid method to account for missing data in economic evaluations [35,36]. Third, while the EQ-5D-3L is generally considered valid for use in COPD populations [26], evidence also exist that the measure might miss important generic and specific items of relevance for COPD populations, among which are breathing [38], cough and dyspnoea [39,40]. Moreover, the EQ-5D-3L was measured at month 1 after randomisation, month 3 and every 3 months thereafter until month 24.…”