Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium-olodaterol for patients with COPD in the Netherlands

• Published in: International journal of chronic obstructive pulmonary disease Vol. 11; no. 1; pp. 2191 - 2201
• Main Authors: van Boven, Job Fm, Kocks, Janwillem Wh, Postma, Maarten J
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2016; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Adrenergic beta-2 Receptor Agonists - economics; Adrenergic beta-2 Receptor Agonists - therapeutic use; Age; Aged; Analysis; Benzoxazines - economics; Benzoxazines - therapeutic use; Bronchodilator Agents - economics; Bronchodilator Agents - therapeutic use; budget impact; Budgets; Cholinergic Antagonists - economics; Cholinergic Antagonists - therapeutic use; Chronic illnesses; Chronic obstructive pulmonary disease; Clinical trials; COPD; Cost analysis; Cost-Benefit Analysis; cost-effectiveness; cost-utility; Disease Progression; Drug Combinations; Drug Costs; Economic aspects; Female; Forced Expiratory Volume; health economics; Humans; Lung - drug effects; Lung - physiopathology; Lung diseases, Obstructive; Male; Markov Chains; Markov processes; Medication Adherence; Middle Aged; Models, Economic; Mortality; Netherlands; Original Research; Patients; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Quality of life; Quality-Adjusted Life Years; Respiratory function; Sensitivity analysis; Severity of Illness Index; Time Factors; Tiotropium Bromide - economics; Tiotropium Bromide - therapeutic use; Treatment Outcome; Netherlands; cost-effectiveness; cost–utility; budget impact; COPD; health economics
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S114738

The fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol showed increased effectiveness regarding lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with the use of its mono-components. Yet, while effectiveness and safety have been shown, the health economic implication of this treatment is still unknown. The aim of this study was to assess the cost-utility and budget impact of tiotropium-olodaterol FDC in patients with moderate to very severe COPD in the Netherlands.
A cost-utility study was performed, using an individual-level Markov model. To populate the model, individual patient-level data (age, height, sex, COPD duration, baseline forced expiratory volume in 1 second) were obtained from the tiotropium-olodaterol TOnado trial. In the model, forced expiratory volume in 1 second and patient-level data were extrapolated to utility and survival, and treatment with tiotropium-olodaterol FDC was compared with tiotropium. Cost-utility analysis was performed from the Dutch health care payer's perspective using a 15-year time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%). Both univariate and probabilistic sensitivity analyses were performed. Budget impact was annually assessed over a 5-year time horizon, taking into account different levels of medication adherence.
As a result of cost increases, combined with quality-adjusted life-year (QALY) gains, results showed that tiotropium-olodaterol FDC had an incremental cost-effectiveness ratio of €7,004/QALY. Without discounting, the incremental cost-effectiveness ratio was €5,981/QALY. Results were robust in univariate and probabilistic sensitivity analyses. Budget impact was estimated at €4.3 million over 5 years assuming 100% medication adherence. Scenarios with 40%, 60%, and 80% adherence resulted in lower 5-year incremental cost increases of €1.7, €2.6, and €3.4 million, respectively.
Tiotropium-olodaterol FDC can be considered a cost-effective treatment under current Dutch cost-effectiveness thresholds.