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Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients.

Abstract

PURPOSE

Umeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective.

METHODS

A previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms measured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observational study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed.

RESULTS

UMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY.

CONCLUSION

UMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective.

Authors+Show Affiliations

Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.Pneumology Department, Hospital Universitario de Cruces, CIBER de Enfermedades Respiratorias (CIBERES), Bilbao, Spain.GlaxoSmithKline, Madrid, Spain.Oblikue Consulting, Barcelona, Spain.Oblikue Consulting, Barcelona, Spain.Pneumology Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.

Pub Type(s)

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

Language

eng

PubMed ID

26848262

Citation

Miravitlles, Marc, et al. "Cost-effectiveness of Combination Therapy Umeclidinium/vilanterol Versus Tiotropium in Symptomatic COPD Spanish Patients." International Journal of Chronic Obstructive Pulmonary Disease, vol. 11, 2016, pp. 123-32.
Miravitlles M, Gáldiz JB, Huerta A, et al. Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients. Int J Chron Obstruct Pulmon Dis. 2016;11:123-32.
Miravitlles, M., Gáldiz, J. B., Huerta, A., Villacampa, A., Carcedo, D., & Garcia-Rio, F. (2016). Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients. International Journal of Chronic Obstructive Pulmonary Disease, 11, 123-32. https://doi.org/10.2147/COPD.S94006
Miravitlles M, et al. Cost-effectiveness of Combination Therapy Umeclidinium/vilanterol Versus Tiotropium in Symptomatic COPD Spanish Patients. Int J Chron Obstruct Pulmon Dis. 2016;11:123-32. PubMed PMID: 26848262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients. AU - Miravitlles,Marc, AU - Gáldiz,Juan B, AU - Huerta,Alicia, AU - Villacampa,Alba, AU - Carcedo,David, AU - Garcia-Rio,Francisco, Y1 - 2016/01/18/ PY - 2016/2/6/entrez PY - 2016/2/6/pubmed PY - 2016/10/8/medline KW - COPD KW - cost-effectiveness analysis KW - cost-utility analysis KW - tiotropium KW - umeclidinium/vilanterol SP - 123 EP - 32 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 11 N2 - PURPOSE: Umeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective. METHODS: A previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms measured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observational study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed. RESULTS: UMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY. CONCLUSION: UMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/26848262/Cost_effectiveness_of_combination_therapy_umeclidinium/vilanterol_versus_tiotropium_in_symptomatic_COPD_Spanish_patients_ L2 - https://dx.doi.org/10.2147/COPD.S94006 DB - PRIME DP - Unbound Medicine ER -