COST-EFFECTIVENESS ANALYSIS OF TIOTROPIUM BROMIDE AND SALMETEROL IN THE TREATMENT OF SEVERE CHRONIC OPSTRUCTIVE PULMONARY DISEASE
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Airflow limitation is associated with symptoms of chronic cough, expectoration, and dyspnea on effort. The objective of this pharmacoeconomic study was to examine and compare the cost-effectiveness ratio of tiotropium bromide and salmeterol in the treatment of severe COPD. The analysis was conducted using Markov model, based on data from the literature about the effectiveness and cost calculations from the perspective of the National Health Insurance Fund in Serbia. Effects for each condition are expressed in quality-adjusted life years (QALYs). The model was simulated using Monte Carlo method, for 1000 hypothetical patients. The time horizon was set at five years (60 cycles). The duration of each cycle was one month. The sensitivity analysis was performed with a variation of parameter values by ± 50% and presented by tornado diagram. The results of Monte Carlo simulations demonstrated small difference between these two drugs. Tiotropium bromide was more cost-effective option than salmeterol, ie. 76 873,80 RSD/QALY vs. 77 252,15 RSD/QALY. The results of this study show that use of tiotropium bromide is more useful option for the treatment of severe COPD (stage III), because greater clinical effectiveness is achieved with a little higher cost of treatment compared with salmeterol.
References
Pauwels RA, Buist S, Calverley PMA, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001; 163: 1256-76.
Dewan NA, Fafique S, Kanwar B, et al. Acute exacerbation of COPD, factors associated with poor treatment outcome. Chest 2000; 117: 662-71.
Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest 2000; 117: 398-401.
Andersson F, Borg S, Jansson SA, et al. The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med 2002; 96: 700-8.
Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847-52.
Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1608-13.
Rennard S, Decramer M, Calverley PM, et al. Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey. Eur Respir J 2002; 20: 799-805.
Starkie HJ, Briggs AH, Chambers MG. Pharmacoeconomics in COPD: lessons for the future. Int J Chron Obstruct Pulmon Dis 2008; 3: 71-88.
Halpin DM, Miravitlles M. Chronic obstructive pulmonary disease: the disease and its burden to society. Proc Am Thorac Soc 2006; 3: 619-23.
Mannino DM, Kiriz VA. Changing the burden of COPD mortality. Int J Chron Obstruct Pulmon Dis 2006; 1: 219-33.
Detournay B, Pribil C, Fournier M, Housset B, Huchon G, Huas D, et al. The SCOPE study: health-care consumption related to patients with chronic obstructive pulmonary disease in France. Value Health 2004; 7: 168-74.
Rutten-van Mölken MP, Oostenbrink JB, Miravitlles M, Monz BU. Modelling the 5-year cost effectiveness of tiotropium, salmeterol and ipratropium for the treatment of chronic obstructive pulmonary disease in Spain. Eur J Health Econ 2007; 8: 123-35.
Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176: 532-55.
Oostenbrink JB, Rutten-van Mölken MP, Monz BU, FitzGerald JM. Probabilistic Markov model to assess the cost-effectiveness of bronchodilator therapy in COPD patients in different countries. Value Health 2005; 8: 32-46.
Gani R, Griffin J, Kelly S, Rutten-van Mölken M. Economic analyses comparing tiotropium with ipratropium or salmeterol in UK patients with COPD. Prim Care Respir J 2010; 19: 68-74.
Oba Y. Cost-effectiveness of long-acting bronchodilators for chronic obstructive pulmonary disease. Mayo Clin Proc 2007; 82: 575-82.
García Ruiz AJ, Leiva Fernández F, Martos Crespo F. Cost-effectiveness analysis of tiotropium compared to ipratropium and salmeterol. Arch Bronconeumol 2005; 41: 242-8.
Oostenbrink JB, Al MJ, Oppe M, Rutten-van Mölken MP. Expected value of perfect information: an empirical example of reducing decision uncertainty by conducting additional research. Value Health 2008; 11: 1070-80.
Oostenbrink JB, Rutten-van Mölken MP, Al MJ, Van Noord JA, Vincken W. One-year cost-effectiveness of tiotropium versus ipratropium to treat chronic obstructive pulmonary disease. Eur Respir J 2004; 23: 241-9.