Cost-effectiveness analysis of a fixed-dose combination of indacaterol and glycopyrronium as maintenance treatment for COPD
Journal
International Journal of COPD
Journal Volume
13
Pages
1079-1088
Date Issued
2018
Author(s)
Abstract
Objective: The aim of this study was to evaluate the cost-effectiveness of the long-acting beta-2 agonist (LABA)/long-acting muscarinic antagonist (LAMA) dual bronchodilator indacaterol/glycopyrronium (IND/GLY) as a maintenance treatment for COPD patients from the perspective of health care payer in Taiwan. Patients and methods: We adopted a patient-level simulation model, which included a cohort of COPD patients aged ?40 years. The intervention used in the study was the treatment using IND/GLY, and comparators were tiotropium or salmeterol/fluticasone combination (SFC). Data related to the efficacy of drugs, incidence of exacerbation, and utility were obtained from clinical studies. Direct costs were estimated from claims data based on the severity of COPD. The cycle length was 6 months (to match forced expiratory volume in 1 second [FEV1] data), and the time horizons included 1, 3, 5, 10 years, and lifetime. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the model results. Costs were expressed in US dollars with a discount rate of 3.0%. Results: Compared to tiotropium and SFC, the incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) gained of patients treated with IND/GLY were US$5,987 and US$14,990, respectively. One-way sensitivity analysis revealed that the improvement in FEV1 provided by IND/GLY, the distribution of patients with regard to the severity of COPD, and acute exacerbation rate ratio were the key drivers behind cost-effectiveness. Adopting a willingness to pay of US$60,000 per QALY gained as the threshold, there was a 98.7% probability that IND/GLY was cost-effective compared to tiotropium. Similarly, there was a 99.9% probability that IND/GLY was cost-effective compared to SFC. Conclusion: As a maintenance treatment for COPD, we consider the dual bronchodilator IND/GLY as a cost-effective strategy when compared to either tiotropium or SFC. ? 2018 Chan et al.
Subjects
COPD; Cost-effectiveness; ICS/LABA combination; Indacaterol/glycopyrronium; LABA/LAMA dual bronchodilator; Maintenance therapy
SDGs
Other Subjects
fluticasone propionate plus salmeterol; glycopyrronium bromide plus indacaterol; tiotropium bromide; beta 2 adrenergic receptor stimulating agent; bronchodilating agent; glycopyrronium; indacaterol-glycopyrronium combination; indan derivative; muscarinic receptor blocking agent; quinolone derivative; Article; chronic obstructive lung disease; cohort analysis; controlled study; cost effectiveness analysis; disease exacerbation; disease severity; drug efficacy; forced expiratory volume; health care cost; human; incidence; maintenance therapy; probability; quality of life; sensitivity analysis; simulation; Taiwan; adult; chronic obstructive lung disease; comparative study; computer simulation; cost benefit analysis; drug cost; drug effect; economic model; economics; female; lung; male; pathophysiology; quality adjusted life year; severity of illness index; time factor; treatment outcome; Adrenergic beta-2 Receptor Agonists; Adult; Bronchodilator Agents; Computer Simulation; Cost-Benefit Analysis; Disease Progression; Drug Costs; Female; Forced Expiratory Volume; Glycopyrrolate; Humans; Indans; Lung; Male; Models, Economic; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive; Quality of Life; Quality-Adjusted Life Years; Quinolones; Severity of Illness Index; Taiwan; Time Factors; Treatment Outcome
Publisher
Dove Medical Press Ltd.
Type
journal article