Cost-Effectiveness of Aclidinium Bromide Compared with Tiotropium Bromide from the Perspective of Copd Patient Populations

Abstract

Objective: To assess the cost­effectiveness of aclidinium vs. tiotropium in GOLD II, III, & IV COPD patients from the perspective of COPD patient populations. Methods: A cost-utility analysis was performed using the perspective of >65 yearold Medicare COPD patient populations. A Markov model decision tree was utilized to compare aclidinium and tiotropium in order to measure cost per qualityadjusted life year (QALY) gained for each treatment method. Sensitivity analyses were conducted for variables with uncertainty (e.g., exacerbations, recurrent exacerbations) in the aclidinium arm and patients’ Medicare Part D plan costs. Results: Aclidinium yielded $60,817 and 13.49 QALYs over the treatment period and tiotropium yielded $36,963 and 13.12 QALYs, leading to a final incremental cost-effectiveness ratio (ICER) of $63,718/QALY for aclidinium vs. tiotropium in the base case analysis. Two-way sensitivity analyses related to annual drug costs suggested that as aclidinium cost falls below $2,400, it is preferred to tiotropium at any cost. Costs above $3,400 favor tiotropium therapy. For higher threshold willingness-to-pay (WTP) of $110, 840 (based on WTP for dialysis in the U.S.), aclidinium becomes preferable at a much higher cost (<$3,700). A higher exacerbation rate (40%) for aclidinium from the base case yields an ICER of $73,353/QALY. Conclusions: Based on the cost-utility analysis, aclidinium was found to be slightly more effective at a much larger incremental cost when compared to tiotropium. Large variability in patient costs based on the various Medicare Part D plans available resulted in a wide range of ICERs.