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Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis.

Abstract

PURPOSE

Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting.

PATIENTS AND METHODS

A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis.

RESULTS

Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness.

CONCLUSION

The treatment algorithm recommended in UK clinical practice represents a cost-effective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy.

Authors+Show Affiliations

IMS Consulting Group, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22500119

Citation

Hertel, Nadine, et al. "Cost-effectiveness of Available Treatment Options for Patients Suffering From Severe COPD in the UK: a Fully Incremental Analysis." International Journal of Chronic Obstructive Pulmonary Disease, vol. 7, 2012, pp. 183-99.
Hertel N, Kotchie RW, Samyshkin Y, et al. Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis. Int J Chron Obstruct Pulmon Dis. 2012;7:183-99.
Hertel, N., Kotchie, R. W., Samyshkin, Y., Radford, M., Humphreys, S., & Jameson, K. (2012). Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis. International Journal of Chronic Obstructive Pulmonary Disease, 7, 183-99. https://doi.org/10.2147/COPD.S29820
Hertel N, et al. Cost-effectiveness of Available Treatment Options for Patients Suffering From Severe COPD in the UK: a Fully Incremental Analysis. Int J Chron Obstruct Pulmon Dis. 2012;7:183-99. PubMed PMID: 22500119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis. AU - Hertel,Nadine, AU - Kotchie,Robert W, AU - Samyshkin,Yevgeniy, AU - Radford,Matthew, AU - Humphreys,Samantha, AU - Jameson,Kevin, Y1 - 2012/03/19/ PY - 2012/4/14/entrez PY - 2012/4/14/pubmed PY - 2012/6/26/medline KW - COPD KW - cost-effectiveness KW - economic KW - exacerbations KW - modeling KW - treatment SP - 183 EP - 99 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 7 N2 - PURPOSE: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting. PATIENTS AND METHODS: A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis. RESULTS: Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness. CONCLUSION: The treatment algorithm recommended in UK clinical practice represents a cost-effective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/22500119/Cost_effectiveness_of_available_treatment_options_for_patients_suffering_from_severe_COPD_in_the_UK:_a_fully_incremental_analysis_ L2 - https://dx.doi.org/10.2147/COPD.S29820 DB - PRIME DP - Unbound Medicine ER -