Cargando…

Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis

PURPOSE: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with...

Descripción completa

Detalles Bibliográficos
Autores principales: Hertel, Nadine, Kotchie, Robert W, Samyshkin, Yevgeniy, Radford, Matthew, Humphreys, Samantha, Jameson, Kevin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325000/
https://www.ncbi.nlm.nih.gov/pubmed/22500119
http://dx.doi.org/10.2147/COPD.S29820
_version_ 1782229376684785664
author Hertel, Nadine
Kotchie, Robert W
Samyshkin, Yevgeniy
Radford, Matthew
Humphreys, Samantha
Jameson, Kevin
author_facet Hertel, Nadine
Kotchie, Robert W
Samyshkin, Yevgeniy
Radford, Matthew
Humphreys, Samantha
Jameson, Kevin
author_sort Hertel, Nadine
collection PubMed
description PURPOSE: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting. PATIENTS AND METHODS: A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis. RESULTS: Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness. CONCLUSION: The treatment algorithm recommended in UK clinical practice represents a costeffective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy.
format Online
Article
Text
id pubmed-3325000
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-33250002012-04-12 Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis Hertel, Nadine Kotchie, Robert W Samyshkin, Yevgeniy Radford, Matthew Humphreys, Samantha Jameson, Kevin Int J Chron Obstruct Pulmon Dis Original Research PURPOSE: Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting. PATIENTS AND METHODS: A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis. RESULTS: Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness. CONCLUSION: The treatment algorithm recommended in UK clinical practice represents a costeffective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy. Dove Medical Press 2012 2012-03-19 /pmc/articles/PMC3325000/ /pubmed/22500119 http://dx.doi.org/10.2147/COPD.S29820 Text en © 2012 Hertel et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Original Research
Hertel, Nadine
Kotchie, Robert W
Samyshkin, Yevgeniy
Radford, Matthew
Humphreys, Samantha
Jameson, Kevin
Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis
title Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis
title_full Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis
title_fullStr Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis
title_full_unstemmed Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis
title_short Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis
title_sort cost-effectiveness of available treatment options for patients suffering from severe copd in the uk: a fully incremental analysis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325000/
https://www.ncbi.nlm.nih.gov/pubmed/22500119
http://dx.doi.org/10.2147/COPD.S29820
work_keys_str_mv AT hertelnadine costeffectivenessofavailabletreatmentoptionsforpatientssufferingfromseverecopdintheukafullyincrementalanalysis
AT kotchierobertw costeffectivenessofavailabletreatmentoptionsforpatientssufferingfromseverecopdintheukafullyincrementalanalysis
AT samyshkinyevgeniy costeffectivenessofavailabletreatmentoptionsforpatientssufferingfromseverecopdintheukafullyincrementalanalysis
AT radfordmatthew costeffectivenessofavailabletreatmentoptionsforpatientssufferingfromseverecopdintheukafullyincrementalanalysis
AT humphreyssamantha costeffectivenessofavailabletreatmentoptionsforpatientssufferingfromseverecopdintheukafullyincrementalanalysis
AT jamesonkevin costeffectivenessofavailabletreatmentoptionsforpatientssufferingfromseverecopdintheukafullyincrementalanalysis