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Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

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  • Maureen Rutten-van Mölken
  • Lucas Goossens

Abstract

Background: Over 200 million people have chronic obstructive pulmonary disease (COPD) worldwide. The number of disease-year equivalents and deaths attributable to COPD are high.Guidelines for the pharmacological treatment of the disease recommend an individualized step-up approach in which treatment is intensified when results are unsatisfactory. Objective: Our objective was to present a systematic review of the cost effectiveness of pharmacological maintenance treatment for COPD and to discuss the methodological strengths and weaknesses of the studies. Methods: A systematic literature search for economic evaluations of drug therapy in COPD was performed inMEDLINE, EMBASE, the Economic Evaluation Database of the UK NHS (NHS-EED) and the European Network of Health Economic Evaluation Databases (EURONHEED). Full economic evaluations presenting both costs and health outcomes were included. Results: A total of 40 studies were included in the review.Of these, 16 were linked to a clinical trial, 14 usedMarkovmodels, eight were based on observational data and two used a different approach. The few studies on combining short-acting bronchodilators were consistent in finding net cost savings compared with monotherapy. Studies comparing inhaled corticosteroids (ICS) with placebo or no maintenance treatment reported inconsistent results. Studies comparing fluticasone with salmeterol consistently found salmeterol to be more cost effective. The cost-effectiveness studies of tiotropium versus placebo, ipratropium or salmeterol pointed towards a reduction in total COPD-related healthcare costs for tiotropium in many but not all studies. All of these studies reported additional health benefits of tiotropium. The cost-effectiveness studies of the combination of inhaled long-acting β 2 -agonists and ICS all report additional health benefits at an increase in total COPD-related costs in most studies. The cost-per-QALY estimates of this combination treatment vary widely and are very sensitive to the assumptions on mortality benefit and time horizon. Conclusions: The currently available economic evaluations indicate differences in cost effectiveness between COPD maintenance therapies, but for a more meaningful comparison of results it is important to improve the consistency with respect to study methodology and choice of comparator. Copyright Springer International Publishing AG 2012

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  • Maureen Rutten-van Mölken & Lucas Goossens, 2012. "Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease," PharmacoEconomics, Springer, vol. 30(4), pages 271-302, April.
    • Handle: RePEc:spr:pharme:v:30:y:2012:i:4:p:271-302
    DOI: 10.2165/11589270-000000000-00000
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Maureen Rutten-van Mölken & Jan Oostenbrink & Marc Miravitlles & Brigitta Monz, 2007. "Modelling the 5-year cost effectiveness of tiotropium, salmeterol and ipratropium for the treatment of chronic obstructive pulmonary disease in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 123-135, June.
    3. Michael Spencer & Andrew Briggs & Ronald Grossman & Laureen Rance, 2005. "Development of an economic model to assess the cost effectiveness of treatment interventions for chronic obstructive pulmonary disease," PharmacoEconomics, Springer, vol. 23(6), pages 619-637, June.
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