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Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients.
Int J Chron Obstruct Pulmon Dis. 2007; 2(2):169-76.IJ

Abstract

Current practice guidelines for the treatment of COPD recommend the use of combined inhaled corticosteroids and long-acting bronchodilators in severe and very severe patients (GOLD stages III and IV). The aim of this study was to evaluate, through a simulation model, the economic consequences of this recommendation in Italy. We developed a cost-effectiveness analysis (CEA) on five alternative therapeutic strategies (salmeterol/fluticasone, SF; formoterol! budesonide, FB; salmeterol alone, S; fluticasone alone, F; control, C). Published data on the Italian COPD population and efficacy data from international reference trials were fitted in a disease progression model based on a Markov chain representing severity stages and death. The yearly total direct costs of treating COPD patients in Italy was estimated at approximately Euro 7 billion, with a mean cost per patient per year of around Euro 2450. Mean survival of the cohort is 11.5 years. The C and F strategies were dominated (ie, are associated with worse outcomes and higher costs) by all alternatives. SF and FB were the most effective strategies, with a slight clinical superiority of SF, but they were also marginally more expensive than S. Incremental cost-effectiveness of SF vs S was Euro 679.5 per avoided exacerbation and Euro 3.3 per symptom-free day. Compared with current practice, the recommended use of combined inhaled corticosteroids and long-acting bronchodilators for severe and very severe COPD patients has the potential for improving clinical outcomes without increasing healthcare costs.

Authors+Show Affiliations

Lung Dept., Orlandi General Hospital, Bussolengo,Verona, Italy. rdalnegro@ulss22.ven.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18044689

Citation

Dal, Negro Roberto, et al. "Cost-effectiveness and Healthcare Budget Impact in Italy of Inhaled Corticosteroids and Bronchodilators for Severe and Very Severe COPD Patients." International Journal of Chronic Obstructive Pulmonary Disease, vol. 2, no. 2, 2007, pp. 169-76.
Dal NR, Eandi M, Pradelli L, et al. Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients. Int J Chron Obstruct Pulmon Dis. 2007;2(2):169-76.
Dal, N. R., Eandi, M., Pradelli, L., & Iannazzo, S. (2007). Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients. International Journal of Chronic Obstructive Pulmonary Disease, 2(2), 169-76.
Dal NR, et al. Cost-effectiveness and Healthcare Budget Impact in Italy of Inhaled Corticosteroids and Bronchodilators for Severe and Very Severe COPD Patients. Int J Chron Obstruct Pulmon Dis. 2007;2(2):169-76. PubMed PMID: 18044689.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients. AU - Dal,Negro Roberto, AU - Eandi,M, AU - Pradelli,L, AU - Iannazzo,S, PY - 2007/11/30/pubmed PY - 2008/1/19/medline PY - 2007/11/30/entrez SP - 169 EP - 76 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 2 IS - 2 N2 - Current practice guidelines for the treatment of COPD recommend the use of combined inhaled corticosteroids and long-acting bronchodilators in severe and very severe patients (GOLD stages III and IV). The aim of this study was to evaluate, through a simulation model, the economic consequences of this recommendation in Italy. We developed a cost-effectiveness analysis (CEA) on five alternative therapeutic strategies (salmeterol/fluticasone, SF; formoterol! budesonide, FB; salmeterol alone, S; fluticasone alone, F; control, C). Published data on the Italian COPD population and efficacy data from international reference trials were fitted in a disease progression model based on a Markov chain representing severity stages and death. The yearly total direct costs of treating COPD patients in Italy was estimated at approximately Euro 7 billion, with a mean cost per patient per year of around Euro 2450. Mean survival of the cohort is 11.5 years. The C and F strategies were dominated (ie, are associated with worse outcomes and higher costs) by all alternatives. SF and FB were the most effective strategies, with a slight clinical superiority of SF, but they were also marginally more expensive than S. Incremental cost-effectiveness of SF vs S was Euro 679.5 per avoided exacerbation and Euro 3.3 per symptom-free day. Compared with current practice, the recommended use of combined inhaled corticosteroids and long-acting bronchodilators for severe and very severe COPD patients has the potential for improving clinical outcomes without increasing healthcare costs. SN - 1176-9106 UR - https://www.unboundmedicine.com/medline/citation/18044689/abstract/Cost_effectiveness_and_healthcare_budget_impact_in_Italy_of_inhaled_corticosteroids_and_bronchodilators_for_severe_and_very_severe_COPD_patients_ L2 - https://www.dovepress.com/articles.php?article_id=493 DB - PRIME DP - Unbound Medicine ER -