Yuji Oba1. 1. Department of Pulmonary, Critical Care and Environmental Medicine, University of Missouri-Columbia, One Hospital Dr, Health Science Center MA419A, Columbia, MO 65212, USA. obay@health.missouri.edu
Abstract
OBJECTIVE: To assess the incremental cost-effectiveness of inhaled medication use in chronic obstructive pulmonary disease (COPD). STUDY DESIGN: A Markov model was constructed to estimate the incremental quality-adjusted life-years (QALYs) gained of the alternative treatment arms used in the Towards a Revolution in COPD Health (TORCH) study (ie, salmeterol-fluticasone propionate combination [SFC], salmeterol, fluticasone, and placebo). METHODS: The cycle length for the model was set to 3 months, and the maximum time horizon was set to 3 years. The cost-effective analysis was conducted from a third-party payer's perspective in the US healthcare system. Future costs and effects were discounted at 3%. Multiple 1-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were performed to handle uncertainty. RESULTS: The most cost-effective strategies are placebo (as-needed short-acting bronchodilator use with no maintenance therapy) when willingness to pay (WTP) is less than $52,800/QALY gained and SFC when WTP exceeds that threshold. When no maintenance therapy is not an acceptable option, the most cost-effective strategies are treatment with salmeterol when WTP is less than $49,500/QALY gained and treatment with SFC when WTP exceeds that threshold. The base-case analysis showed that incremental cost-effectiveness ratios of salmeterol, fluticasone, and SFC relative to placebo were $56,519, $62,833, and $52,046/QALY gained, respectively. CONCLUSIONS: The most cost-effective strategy in moderate-to-severe COPD depends on how much society is willing to pay to achieve health improvements. When treatment with as-needed short-acting bronchodilator use does not provide adequate control, salmeterol or SFC would be the drug of choice depending on WTP.
RCT Entities:
OBJECTIVE: To assess the incremental cost-effectiveness of inhaled medication use in chronic obstructive pulmonary disease (COPD). STUDY DESIGN: A Markov model was constructed to estimate the incremental quality-adjusted life-years (QALYs) gained of the alternative treatment arms used in the Towards a Revolution in COPD Health (TORCH) study (ie, salmeterol-fluticasone propionate combination [SFC], salmeterol, fluticasone, and placebo). METHODS: The cycle length for the model was set to 3 months, and the maximum time horizon was set to 3 years. The cost-effective analysis was conducted from a third-party payer's perspective in the US healthcare system. Future costs and effects were discounted at 3%. Multiple 1-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were performed to handle uncertainty. RESULTS: The most cost-effective strategies are placebo (as-needed short-acting bronchodilator use with no maintenance therapy) when willingness to pay (WTP) is less than $52,800/QALY gained and SFC when WTP exceeds that threshold. When no maintenance therapy is not an acceptable option, the most cost-effective strategies are treatment with salmeterol when WTP is less than $49,500/QALY gained and treatment with SFC when WTP exceeds that threshold. The base-case analysis showed that incremental cost-effectiveness ratios of salmeterol, fluticasone, and SFC relative to placebo were $56,519, $62,833, and $52,046/QALY gained, respectively. CONCLUSIONS: The most cost-effective strategy in moderate-to-severe COPD depends on how much society is willing to pay to achieve health improvements. When treatment with as-needed short-acting bronchodilator use does not provide adequate control, salmeterol or SFC would be the drug of choice depending on WTP.
Authors: Hengameh H Raissy; H William Kelly; Michelle Harkins; Stanley J Szefler Journal: Am J Respir Crit Care Med Date: 2013-04-15 Impact factor: 21.405