Cost Effectiveness of Tiotropium in Patients with Asthma Poorly Controlled on Inhaled Glucocorticosteroids and Long-Acting β-Agonists
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A considerable proportion of patients with asthma remain uncontrolled or symptomatic despite treatment with a high dose of inhaled glucocorticosteroids (ICSs) and long-acting β2-agonists (LABAs). Tiotropium Respimat® added to usual care improves lung function, asthma control, and the frequency of non-severe and severe exacerbations, in a population of adult asthma patients who are uncontrolled despite treatment with ICS/LABA.
This study estimated the cost effectiveness of tiotropium therapy as add-on to usual care in asthma patients that are uncontrolled despite treatment with ICS/LABA combination from the perspective of the UK National Health Service (NHS).
A Markov model was developed which considers levels of asthma control and exacerbations. The model analysed cost and quality-adjusted life-years (QALYs); sensitivity and scenario analyses were also conducted to test the robustness of the base case outcomes. All costs are given at 2012 prices.
The model found that in this category of asthma with unmet need, add-on tiotropium therapy generated an incremental 0.24 QALYs and £5,238 costs over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of £21,906 per QALY gained. Sensitivity analysis suggested that findings were most dependent on the costs of managing uncontrolled asthma and the cost of treatment with tiotropium.
In this modelled analysis of two clinical trials, tiotropium was found to be cost effective when added to usual care in patients who remain uncontrolled despite treatment with high-dose ICS/LABA. Further research should investigate the long-term treatment effectiveness of tiotropium.
KeywordsAsthma Usual Care Asthma Control Tiotropium Probabilistic Sensitivity Analysis
IMS Health (Adam Lloyd, Jenny Willson and Tania Krivasi), funded by Boehringer Ingelheim (Dirk Esser), conducted the analysis described in this paper. Adam Lloyd, Jenny Willson and Tania Krivasi were responsible for designing and building the model, conducting and interpreting the analysis and drafting the manuscript; Adam Lloyd is the guarantor of the overall content. Dirk Esser provided leadership and scientific input into the concept and design of the model, contributed to interpretation of the analysis and critically reviewed the manuscript for intellectual content. Professor Eric Bateman and Professor Ian Pavord were consulted as clinical experts in the treatment of patients with asthma throughout the development of the analysis, contributed to interpretation of the analysis and critically reviewed the manuscript for intellectual content. The authors acknowledge the input of Nadine Hertel in developing the cost-effectiveness model.
Dirk Esser is a full-time employee of Boehringer Ingelheim. Adam Lloyd, Jenny Willson and Tania Krivasi conducted this analysis in their capacity as employees of IMS Health. Professor Eric Bateman is an Emeritus Professor of Medicine at the University of Cape Town and received consulting fees or honoraria from Boehringer Ingelheim for the meetings connected with this study. Professor Ian Pavord is a Professor of Respiratory Medicine at the University of Oxford and received consulting fees or honoraria from Boehringer Ingelheim for the meetings connected with this study.
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