PURPOSE: Inhaled corticosteroids reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD), but their cost-effectiveness is not known. METHODS: We used a Markov model to determine, from a societal perspective, the cost-effectiveness of four treatment strategies involving inhaled corticosteroids: no use regardless of COPD severity; use in all disease stages; use in patients with stage 2 or 3 disease (forced expiratory volume in 1 second [FEV(1)] <50% of predicted); and use in patients with stage 3 disease (FEV(1) <35% of predicted). Data from the literature were used to estimate mortality, exacerbation, and disease progression rates, as well as the costs associated with care and quality-adjusted life-years (QALYs), according to disease stage and use or nonuse of inhaled corticosteroids. A time horizon of 3 years was used. RESULTS: Use of inhaled corticosteroids in patients with stage 2 or 3 disease was associated with a cost of 17,000 dollars per QALY gained. In stage 3 patients, use resulted in a cost of 11,100 dollars per QALY gained. Providing inhaled corticosteroids to all COPD patients was associated with a less favorable cost-effectiveness ratio. Results were robust to various assumptions in a Monte Carlo simulation. CONCLUSION: In patients with COPD, use of inhaled corticosteroids in those with stage 2 or 3 disease for 3 years results in improved quality-adjusted life expectancy at a cost that is similar to that of other therapies commonly used in clinical practice.
PURPOSE: Inhaled corticosteroids reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD), but their cost-effectiveness is not known. METHODS: We used a Markov model to determine, from a societal perspective, the cost-effectiveness of four treatment strategies involving inhaled corticosteroids: no use regardless of COPD severity; use in all disease stages; use in patients with stage 2 or 3 disease (forced expiratory volume in 1 second [FEV(1)] <50% of predicted); and use in patients with stage 3 disease (FEV(1) <35% of predicted). Data from the literature were used to estimate mortality, exacerbation, and disease progression rates, as well as the costs associated with care and quality-adjusted life-years (QALYs), according to disease stage and use or nonuse of inhaled corticosteroids. A time horizon of 3 years was used. RESULTS: Use of inhaled corticosteroids in patients with stage 2 or 3 disease was associated with a cost of 17,000 dollars per QALY gained. In stage 3 patients, use resulted in a cost of 11,100 dollars per QALY gained. Providing inhaled corticosteroids to all COPDpatients was associated with a less favorable cost-effectiveness ratio. Results were robust to various assumptions in a Monte Carlo simulation. CONCLUSION: In patients with COPD, use of inhaled corticosteroids in those with stage 2 or 3 disease for 3 years results in improved quality-adjusted life expectancy at a cost that is similar to that of other therapies commonly used in clinical practice.
Authors: R Nielsen; A Johannessen; B Benediktsdottir; T Gislason; A S Buist; A Gulsvik; S D Sullivan; T A Lee Journal: Eur Respir J Date: 2009-04-08 Impact factor: 16.671
Authors: Emma Gutiérrez de Mesa; Ignacio Hidalgo; Panayotis Christidis; Juan Carlos Ciscar; Eva Vegas; Dolores Ibarreta Journal: Mol Diagn Ther Date: 2007 Impact factor: 4.074
Authors: Maureen P M H Rutten-van Mölken; Floortje E van Nooten; Marion Lindemann; Manfred Caeser; Peter M A Calverley Journal: Pharmacoeconomics Date: 2007 Impact factor: 4.981
Authors: David Price; Yumi Asukai; Jaithri Ananthapavan; Bill Malcolm; Amr Radwan; Ian Keyzor Journal: Appl Health Econ Health Policy Date: 2013-06 Impact factor: 2.561