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Cost-effectiveness of roflumilast as an add-on to triple inhaled therapy vs triple inhaled therapy in patients with severe and very severe COPD associated with chronic bronchitis in the UK.
Int J Chron Obstruct Pulmon Dis. 2018; 13:2707-2720.IJ

Abstract

Purpose

Patients with severe COPD are at high risk of experiencing disease exacerbations, which require additional treatment and are associated with elevated mortality and increased risk of future exacerbations. Some patients continue to experience exacerbations despite receiving triple inhaled therapy (ICS plus LAMA plus LABA). Roflumilast is recommended by the Global Initiative for Chronic Obstructive Lung Disease as add-on treatment to triple inhaled therapy for these patients. This cost-effectiveness analysis compared costs and quality-adjusted life-years for roflumilast plus triple inhaled therapy vs triple inhaled therapy alone, using data from the REACT and RE2SPOND trials.

Patients and methods

Patients included in the analysis had severe to very severe COPD, FEV1 <50% predicted, symptoms of chronic bronchitis and ≥2 exacerbations per year. Our model was adapted from a previously published and validated model, and the analyses conducted from a UK National Health Service perspective. A scenario analysis considered a subset of patients who had experienced at least one COPD-related hospitalization within the previous year.

Results

Roflumilast as add-on to triple inhaled therapy was associated with non-significant reductions in rates of both moderate and severe exacerbations compared with triple inhaled therapy alone. The incremental cost-effectiveness ratio (ICER) for roflumilast as add-on to triple inhaled therapy was £24,976. In patients who had experienced previous hospitalization, roflumilast was associated with a non-significant reduction in the rate of moderate exacerbations, and a statistically significant reduction in the rate of severe exacerbations. The ICER for roflumilast in this population was £7,087.

Conclusions

Roflumilast is a cost-effective treatment option for patients with severe or very severe COPD, chronic bronchitis, and a history of exacerbations. The availability of roflumilast as add-on treatment addresses an important unmet need in this patient population.

Authors+Show Affiliations

ICON plc, Abingdon, UK.AstraZeneca, Barcelona, Spain, sandrine.ruiz@astrazeneca.com.AstraZeneca, Cambridge, UK.AstraZeneca, Luton, UK.ICON plc, Abingdon, UK.Phastar, Manchester, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30214188

Citation

Kiff, Chris, et al. "Cost-effectiveness of Roflumilast as an Add-on to Triple Inhaled Therapy Vs Triple Inhaled Therapy in Patients With Severe and Very Severe COPD Associated With Chronic Bronchitis in the UK." International Journal of Chronic Obstructive Pulmonary Disease, vol. 13, 2018, pp. 2707-2720.
Kiff C, Ruiz S, Varol N, et al. Cost-effectiveness of roflumilast as an add-on to triple inhaled therapy vs triple inhaled therapy in patients with severe and very severe COPD associated with chronic bronchitis in the UK. Int J Chron Obstruct Pulmon Dis. 2018;13:2707-2720.
Kiff, C., Ruiz, S., Varol, N., Gibson, D., Davies, A., & Purkayastha, D. (2018). Cost-effectiveness of roflumilast as an add-on to triple inhaled therapy vs triple inhaled therapy in patients with severe and very severe COPD associated with chronic bronchitis in the UK. International Journal of Chronic Obstructive Pulmonary Disease, 13, 2707-2720. https://doi.org/10.2147/COPD.S167730
Kiff C, et al. Cost-effectiveness of Roflumilast as an Add-on to Triple Inhaled Therapy Vs Triple Inhaled Therapy in Patients With Severe and Very Severe COPD Associated With Chronic Bronchitis in the UK. Int J Chron Obstruct Pulmon Dis. 2018;13:2707-2720. PubMed PMID: 30214188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of roflumilast as an add-on to triple inhaled therapy vs triple inhaled therapy in patients with severe and very severe COPD associated with chronic bronchitis in the UK. AU - Kiff,Chris, AU - Ruiz,Sandrine, AU - Varol,Nebibe, AU - Gibson,Danny, AU - Davies,Andrew, AU - Purkayastha,Debasree, Y1 - 2018/09/03/ PY - 2018/9/15/entrez PY - 2018/9/15/pubmed PY - 2019/1/24/medline KW - National Health Service KW - National Institute for Health and Care Excellence KW - exacerbation rates SP - 2707 EP - 2720 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 13 N2 - Purpose: Patients with severe COPD are at high risk of experiencing disease exacerbations, which require additional treatment and are associated with elevated mortality and increased risk of future exacerbations. Some patients continue to experience exacerbations despite receiving triple inhaled therapy (ICS plus LAMA plus LABA). Roflumilast is recommended by the Global Initiative for Chronic Obstructive Lung Disease as add-on treatment to triple inhaled therapy for these patients. This cost-effectiveness analysis compared costs and quality-adjusted life-years for roflumilast plus triple inhaled therapy vs triple inhaled therapy alone, using data from the REACT and RE2SPOND trials. Patients and methods: Patients included in the analysis had severe to very severe COPD, FEV1 <50% predicted, symptoms of chronic bronchitis and ≥2 exacerbations per year. Our model was adapted from a previously published and validated model, and the analyses conducted from a UK National Health Service perspective. A scenario analysis considered a subset of patients who had experienced at least one COPD-related hospitalization within the previous year. Results: Roflumilast as add-on to triple inhaled therapy was associated with non-significant reductions in rates of both moderate and severe exacerbations compared with triple inhaled therapy alone. The incremental cost-effectiveness ratio (ICER) for roflumilast as add-on to triple inhaled therapy was £24,976. In patients who had experienced previous hospitalization, roflumilast was associated with a non-significant reduction in the rate of moderate exacerbations, and a statistically significant reduction in the rate of severe exacerbations. The ICER for roflumilast in this population was £7,087. Conclusions: Roflumilast is a cost-effective treatment option for patients with severe or very severe COPD, chronic bronchitis, and a history of exacerbations. The availability of roflumilast as add-on treatment addresses an important unmet need in this patient population. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/30214188/Cost_effectiveness_of_roflumilast_as_an_add_on_to_triple_inhaled_therapy_vs_triple_inhaled_therapy_in_patients_with_severe_and_very_severe_COPD_associated_with_chronic_bronchitis_in_the_UK_ L2 - https://dx.doi.org/10.2147/COPD.S167730 DB - PRIME DP - Unbound Medicine ER -