Cost Effectiveness of Budesonide/Formoterol Added to Tiotropium Bromide versus Placebo Added to Tiotropium Bromide in Patients with Chronic Obstructive Pulmonary Disease
- First Online:
- 327 Downloads
Background: Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory lung disease associated with increasing morbidity and mortality and an economic burden that stretches beyond the patient to healthcare systems. Avoiding exacerbations and subsequent hospitalizations is an important clinical aim and can avoid significant costs associated with the disease. International guidelines recommend the addition of an inhaled corticosteroid (ICS) to a long-acting β2-adrenoceptor agonist (LABA) for patients with severe to very severe COPD and a history of exacerbations.
Objective: To evaluate retrospectively over a 3-month period, the cost effectiveness of budesonide/formoterol added to tiotropium bromide (tiotropium) compared with placebo added to tiotropium in COPD patients eligible for ICS/LABA combination therapy, based on the CLIMB study (NCT00496470).
Methods: A cost-effectiveness analysis of data from the 12-week, randomized, double-blind CLIMB study of COPD patients (n = 659; eligible for ICS/ LABA; aged ≥40 years) comparing budesonide/formoterol (Symbicort® Turbuhaler® 320/9 μg twice daily) added to tiotropium (18 μg daily) or placebo added to tiotropium was conducted. A severe exacerbation was defined as a requirement for systemic glucocorticosteroids and/or ED visit and/or hospitalization. The effectiveness variable used for this analysis was the number of severe exacerbations avoided. Direct costs (medications, hospitalizations, ED and GP visits) were calculated by applying year 2009 unit costs from Australia ($A), Canada ($Can) and Sweden (Swedish krona [SEK]) to the study’s pooled resource use. One-way sensitivity analyses for each country’s mean incremental cost-effectiveness ratio and sensitivity to overall exacerbations were conducted. Bootstrapping was performed to estimate the variation around resource use, exacerbations and each country’s mean incremental cost-effectiveness ratio.
Results: The mean number of severe exacerbations per patient 3-month period was 0.11 in the budesonide/formoterol added to tiotropium arm and 0.29 in the placebo added to tiotropium arm–a 62% reduction in the rate of severe exacerbations. Treatment with budesonide/formoterol added to tiotropium costs less in Australia and Canada (-$A90 [-€58] and -$Can4.51 [-€3]) and only slightlymore in Sweden (SEK444 [€43]), i.e. the savings associated with fewer exacerbations more than offset the additional budesonide/formoterol drug cost in Australia and Canada, and partially offset it in Sweden. In the Australian and Canadian perspectives, budesonide/formoterol added to tiotropium was a dominant treatment (fewer exacerbations at a lower cost) comparedwithplacebo added to tiotropium. In Sweden, the estimated incremental cost per avoided exacerbation was SEK2502 (€244.40).
Conclusion: Budesonide/formoterol added to tiotropium was the dominant strategy compared with placebo added to tiotropium based on a 12-week study in COPD patients eligible for ICS/LABA combination therapy in Australia and Canada, and appears to be a cost-effective strategy in Sweden.
- 2.Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease [online]. Available from URL: http://goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=2003 [Accessed 2009 Dec 1]
- 4.Canadian Institute for Health Information. Respiratory disease in Canada [online]. Available from URL: http://www.phac-aspc.gc.ca/publicat/rdc-mrc01/pdf/rdc0901e.pdf [Accessed 2010 Mar 1]Google Scholar
- 5.National Institute for Health and Clinical Excellence. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care [online]. Available from URL: http://guidance.nice.org.uk/CG101/Guidance/pdf/English [Accessed 2010 Mar 1]Google Scholar
- 13.National Institute for Health and Clinical Excellence. Chronic obstructive pulmonary disease (Clinical Guideline 12). London: NICE, 2004 [online]. Available from URL: http://www.nice.org.uk/nicemedia/pdf/CG012_niceguideline.pdf [Accessed 2010 Mar 1]Google Scholar
- 24.Statistics Canada. Consumer price index 2010 [online]. Available from URL: http://www.statcan.gc.ca/subjectssujets/cpi-ipc/cpi-ipc-eng.htm [Accessed 2010 Mar 1]Google Scholar
- 25.OECD exchange rate [online]. Available from URL: http://stats.oecd.org/index.aspx?queryid=169 [Accessed 2010 Apr 14]
- 26.Australian Government Department of Health and Ageing. National hospital cost data collection, round 12, 2009 [online]. Available from URL: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-datacollections-about_NHCDC [Accessed 2010 Mar 1]Google Scholar
- 27.Regional rates and allowances for the Southern Health Care Region in 2009 (Sweden). Unit costs [online]. Available from URL: http://www.skane.se/templates/Page.aspx?id=190940 [Accessed 2010 Mar 1]
- 28.Södra regionvårdsnämnden S. Unit costs primary care, 2009 [online]. Available from URL: http://www.skane.se/upload/Webbplatser/Sodra%20regionvardsnamnden/prislista/2009/188_primarvard_ovr_spec09.pdf [Accessed 2010Mar 1]Google Scholar
- 29.Sweden’s municipalities and counties (Sveriges kommuner och landsting), DRG codes Sweden, 2009 [online]. Available from URL: http://www.skl.se/artikel.asp?C=1334&A=41801 [Accessed 2010 Mar 1]
- 31.The Dental and Pharmaceutical Benefits Agency, TLV (Tandvård- och Läkemedelsförmånsnämnden), 2009 [online]. Available from URL: http://www.tlv.se/ [Accessed 2010 Mar 1]
- 32.Ontario Drug Benefit Formulary/Comparative Drug Index [online]. Available from URL: http://www.healthinfo.moh.gov.on.ca/formulary/ [Accessed 2010 Mar 1]