Abstract
BackgroundCost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective.MethodsA linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George’s Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model.ResultsOver a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (− 0.053; 95% CI: − 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: − £645, − £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (− 0.033; 95% CI: − 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses.ConclusionsFor treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost.Trial registration 201316, NCT02207829; 201315, NCT02236611
Highlights
Cost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a United Kingdom (UK) National Health Service (NHS) perspective
UMEC provided an additional 0.195 life years (LY) and 0.118 quality-adjusted life year (QALY) compared with TIO, with cost savings of £460 (Table 2)
Results of the probabilistic sensitivity analysis (PSA) showed that out of 1000 simulations, 95% resulted in an incremental cost-effectiveness ratio (ICER)/QALY of £284–£2060 (Fig. 1b)
Summary
Cost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective. The benefits of appropriate pharmacological therapy in COPD in decreasing symptoms, reducing the need for rescue therapy, decreasing the frequency and severity of exacerbations, and improving health-related quality of life (HRQoL), are well recognised and summarised along with treatment recommendations in the annually updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategic document [2]. The recommendation for pharmacological treatment of most patients with COPD is bronchodilator monotherapy or dual therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs), depending on disease burden and exacerbation history [2]. These recommendations reflect the central role of bronchodilators in treating COPD [10, 11]. LAMAs have been reported to be more effective than LABAs in reducing the rate of exacerbations and reducing the time to a first moderate or severe exacerbation in patients with moderate-to-very severe COPD [12, 13]
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