Cost effectiveness of therapy with combinations of long acting bronchodilators and inhaled steroids for treatment of COPD
- M Najafzadeh1,
- C A Marra2,3,
- M Sadatsafavi2,
- S D Aaron4,
- S D Sullivan5,
- K L Vandemheen6,
- P W Jones7,
- J M Fitzgerald8
- 1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- 2Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- 3Centre for Health Evaluation and Outcomes Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- 4Faculty of Medicine, University of Ottawa, Respiratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- 5Medicine, and Public Health and Community Medicine, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA
- 6Respirology Research, The Ottawa Hospital, Ottawa, Ontario, Canada
- 7Respiratory Medicine, St George’s, University of London, London, UK
- 8Division of Respiratory Medicine, Faculty of Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Dr C Marra, St Paul’s Hospital, 620B-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Carlo.marra{at}ubc.ca
- Received 28 August 2007
- Accepted 22 May 2008
- Published Online First 11 July 2008
Abstract
Background: Little is known about the combination of different medications in chronic obstructive pulmonary disease (COPD). This study determined the cost effectiveness of adding salmeterol (S) or fluticasone/salmeterol (FS) to tiotropium (T) for COPD.
Methods: This concurrent, prospective, economic analysis was based on costs and health outcomes from a 52 week randomised study comparing: (1) T 18 µg once daily + placebo twice daily (TP group); (2) T 18 µg once daily + S 25 µg/puff, 2 puffs twice daily (TS group); and (3) T 18 µg once daily + FS 250/25 µg/puff, 2 puffs twice daily (TFS group). The incremental cost effectiveness ratios (ICERs) were defined as incremental cost per exacerbation avoided, and per additional quality adjusted life year (QALY) between treatments. A combination of imputation and bootstrapping was used to quantify uncertainty, and extensive sensitivity analyses were performed.
Results: The average patient in the TP group generated CAN$2678 in direct medical costs compared with $2801 (TS group) and $4042 (TFS group). The TS strategy was dominated by TP and TFS. Compared with TP, the TFS strategy resulted in ICERs of $6510 per exacerbation avoided, and $243 180 per QALY gained. In those with severe COPD, TS resulted in equal exacerbation rates and slightly lower costs compared with TP.
Conclusions: TFS had significantly better quality of life and fewer hospitalisations than patients treated with TP but these improvements in health outcomes were associated with increased costs. Neither TFS nor TS are economically attractive alternatives compared with monotherapy with T.
Footnotes
-
Funding: This study was funded, in part, by the National Sanitarium Association, Ontario, Canada and the Canadian Institutes of Health Research (CIHR) through an operating grant for the clinical trial. CAM is funded by a Canada Research Chair in Pharmaceutical Outcomes and a Michael Smith Foundation for Health Research Scholar Award in Health Services Research. JMF is funded by a Michael Smith Foundation for Health Research Distinguished Scholar Award and a CIHR/BC Lung Association Investigator Award. SDA holds a CIHR New Investigator Award.
-
Competing interests: None.
-
Ethics approval: Ethics approval was obtained.
