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Cost-effectiveness of roflumilast as an add-on treatment to long-acting bronchodilators in the treatment of COPD associated with chronic bronchitis in the United Kingdom.
Eur J Health Econ. 2014 Jan; 15(1):69-82.EJ

Abstract

OBJECTIVE

To estimate the cost-effectiveness of adding a selective phosphodiesterase-4 inhibitor, roflumilast, to a long-acting bronchodilator therapy (LABA) for the treatment of patients with severe-to-very severe chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis with a history of frequent exacerbations from the UK payer perspective.

METHODS

A Markov model was developed to predict the lifetime cost and outcomes [exacerbations rates, life expectancy, and quality-adjusted life years (QALY)] in patients treated with roflumilast, which showed a reduction in the exacerbation rates and lung function improvement in a pooled analysis from two clinical trials, M2-124 and M2-125. Sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness.

RESULTS

The addition of roflumilast to concomitant LABA reduced the number of exacerbations from 15.6 to 12.7 [2.9 (95 % CI 0.88-4.92) exacerbations avoided] and increased QALYs from 5.45 to 5.61 [0.16 (95 % CI 0.02-0.31) QALYs gained], at an incremental cost of £3,197 (95 % CI £2,135-£4,253). Cost in LABA alone and LABA + roflumilast were £16,161 and £19,358 respectively. The incremental cost-effectiveness ratios in the base case were £19,505 (95 % CI £364-£38,646) per quality-adjusted life-year gained and 18,219 (95 % CI £12,697-£49,135) per life-year gained. Sensitivity analyses suggest that among the main determinants of cost-effectiveness are the reduction of exacerbations and the case fatality rate due to hospital-treated exacerbations. Probabilistic sensitivity analysis suggests that the probability of roflumilast being cost-effective is 82 % at willingness-to-pay £30,000 per QALY.

CONCLUSIONS

The addition of roflumilast to LABA in the treatment of patients with severe-to-very severe COPD reduces the rate of exacerbations and can be cost-effective in the UK setting.

Authors+Show Affiliations

IMS Health, 210 Pentonville Road, London, N1 9JY, UK, ysamyshkin@uk.imshealth.com.No 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

23392624

Citation

Samyshkin, Yevgeniy, et al. "Cost-effectiveness of Roflumilast as an Add-on Treatment to Long-acting Bronchodilators in the Treatment of COPD Associated With Chronic Bronchitis in the United Kingdom." The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care, vol. 15, no. 1, 2014, pp. 69-82.
Samyshkin Y, Kotchie RW, Mörk AC, et al. Cost-effectiveness of roflumilast as an add-on treatment to long-acting bronchodilators in the treatment of COPD associated with chronic bronchitis in the United Kingdom. Eur J Health Econ. 2014;15(1):69-82.
Samyshkin, Y., Kotchie, R. W., Mörk, A. C., Briggs, A. H., & Bateman, E. D. (2014). Cost-effectiveness of roflumilast as an add-on treatment to long-acting bronchodilators in the treatment of COPD associated with chronic bronchitis in the United Kingdom. The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care, 15(1), 69-82. https://doi.org/10.1007/s10198-013-0456-5
Samyshkin Y, et al. Cost-effectiveness of Roflumilast as an Add-on Treatment to Long-acting Bronchodilators in the Treatment of COPD Associated With Chronic Bronchitis in the United Kingdom. Eur J Health Econ. 2014;15(1):69-82. PubMed PMID: 23392624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of roflumilast as an add-on treatment to long-acting bronchodilators in the treatment of COPD associated with chronic bronchitis in the United Kingdom. AU - Samyshkin,Yevgeniy, AU - Kotchie,Robert W, AU - Mörk,Ann-Christin, AU - Briggs,Andrew H, AU - Bateman,Eric D, Y1 - 2013/02/08/ PY - 2012/01/27/received PY - 2013/01/15/accepted PY - 2013/2/9/entrez PY - 2013/2/9/pubmed PY - 2014/9/23/medline SP - 69 EP - 82 JF - The European journal of health economics : HEPAC : health economics in prevention and care JO - Eur J Health Econ VL - 15 IS - 1 N2 - OBJECTIVE: To estimate the cost-effectiveness of adding a selective phosphodiesterase-4 inhibitor, roflumilast, to a long-acting bronchodilator therapy (LABA) for the treatment of patients with severe-to-very severe chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis with a history of frequent exacerbations from the UK payer perspective. METHODS: A Markov model was developed to predict the lifetime cost and outcomes [exacerbations rates, life expectancy, and quality-adjusted life years (QALY)] in patients treated with roflumilast, which showed a reduction in the exacerbation rates and lung function improvement in a pooled analysis from two clinical trials, M2-124 and M2-125. Sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness. RESULTS: The addition of roflumilast to concomitant LABA reduced the number of exacerbations from 15.6 to 12.7 [2.9 (95 % CI 0.88-4.92) exacerbations avoided] and increased QALYs from 5.45 to 5.61 [0.16 (95 % CI 0.02-0.31) QALYs gained], at an incremental cost of £3,197 (95 % CI £2,135-£4,253). Cost in LABA alone and LABA + roflumilast were £16,161 and £19,358 respectively. The incremental cost-effectiveness ratios in the base case were £19,505 (95 % CI £364-£38,646) per quality-adjusted life-year gained and 18,219 (95 % CI £12,697-£49,135) per life-year gained. Sensitivity analyses suggest that among the main determinants of cost-effectiveness are the reduction of exacerbations and the case fatality rate due to hospital-treated exacerbations. Probabilistic sensitivity analysis suggests that the probability of roflumilast being cost-effective is 82 % at willingness-to-pay £30,000 per QALY. CONCLUSIONS: The addition of roflumilast to LABA in the treatment of patients with severe-to-very severe COPD reduces the rate of exacerbations and can be cost-effective in the UK setting. SN - 1618-7601 UR - https://www.unboundmedicine.com/medline/citation/23392624/Cost_effectiveness_of_roflumilast_as_an_add_on_treatment_to_long_acting_bronchodilators_in_the_treatment_of_COPD_associated_with_chronic_bronchitis_in_the_United_Kingdom_ L2 - https://dx.doi.org/10.1007/s10198-013-0456-5 DB - PRIME DP - Unbound Medicine ER -