Cost-effectiveness of salmeterol, fluticasone, and combination therapy for COPD

• Published in: The American journal of managed care Vol. 15; no. 4; pp. 226 - 232
• Main Author: Oba, Yuji
• Format: Journal Article
• Language: English
• Published: United States 01-04-2009
• Subjects: Aged; Albuterol - analogs & derivatives; Albuterol - economics; Albuterol - therapeutic use; Androstadienes - economics; Androstadienes - therapeutic use; Bronchodilator Agents - economics; Bronchodilator Agents - therapeutic use; Cost-Benefit Analysis; Drug Therapy, Combination; Female; Fluticasone; Health administration; Humans; Male; Markov Chains; Monte Carlo Method; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - economics; Quality-Adjusted Life Years; Salmeterol Xinafoate
• ISSN: 1936-2692

To assess the incremental cost-effectiveness of inhaled medication use in chronic obstructive pulmonary disease (COPD).
A Markov model was constructed to estimate the incremental quality-adjusted life-years (QALYs) gained of the alternative treatment arms used in the Towards a Revolution in COPD Health (TORCH) study (ie, salmeterol-fluticasone propionate combination [SFC], salmeterol, fluticasone, and placebo).
The cycle length for the model was set to 3 months, and the maximum time horizon was set to 3 years. The cost-effective analysis was conducted from a third-party payer's perspective in the US healthcare system. Future costs and effects were discounted at 3%. Multiple 1-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were performed to handle uncertainty.
The most cost-effective strategies are placebo (as-needed short-acting bronchodilator use with no maintenance therapy) when willingness to pay (WTP) is less than $52,800/QALY gained and SFC when WTP exceeds that threshold. When no maintenance therapy is not an acceptable option, the most cost-effective strategies are treatment with salmeterol when WTP is less than $49,500/QALY gained and treatment with SFC when WTP exceeds that threshold. The base-case analysis showed that incremental cost-effectiveness ratios of salmeterol, fluticasone, and SFC relative to placebo were $56,519, $62,833, and $52,046/QALY gained, respectively.
The most cost-effective strategy in moderate-to-severe COPD depends on how much society is willing to pay to achieve health improvements. When treatment with as-needed short-acting bronchodilator use does not provide adequate control, salmeterol or SFC would be the drug of choice depending on WTP.