Meta-analysis of cost-effectiveness of three-drug therapy versus two-drug therapy in chronic obstructive pulmonary disease patients

Syed Aamir Ali,Sharma Ganesh Narayan,Mohd Aleemuddin Naveed,Shrivastav Birendra

doi:10.7324/japs.2021.110916

Abstract

Healthcare expenditures on chronic obstructive pulmonary disease (COPD) have increased substantially globally. Thus, there is a need to find a cost-effective approach for the treatment of COPD. This meta-analysis aimed to evaluate the cost-effectiveness of triple therapy [long acting beta2 agonists (LABA)/long-acting muscarinic antagonist (LAMA)/inhaled corticosteroids (ICS)] versus dual therapy (LABA/LAMA and LABA/ICS) in moderate to severe COPD patients. Studies evaluating the cost-effectiveness of triple therapy versus dual therapy were identified through PubMed and Scopus from 2011 (January) to 2021(January) and meta-analyzed using a random-effects model. Results were presented as standardized mean differences (SMD) of quality-adjusted life years (QALY), life years (LY) gained, Costs, incremental cost-effectiveness ratios (ICER), incremental net monetary benefits (INMB), and incremental net health benefits (INHB). Of the 125 studies identified, four model analyses were included and meta-analyzed. QALY [SMD: 0.22; 95% confidence interval (CI): 0.16, 0.28], LY gained (SMD: 0.14; 95% CI: 0.10, 0.19), ICER (SMD: 0.96; 95% CI: 0.55, 1.38), INMB (SMD: 0.14; 95% CI: 0.12, 0.16), and INHB (SMD: 0.17; 95% CI: 0.13, 0.21) favored triple therapy. The results indicate that triple therapy is cost-effective than dual therapy in moderate to severe COPD patients as it provides more QALY and LY but at an additional cost.

Highlights

Chronic obstructive pulmonary disease (COPD) is an advancing pulmonary disorder distinguished by diminished airflow and enhanced chronic inflammatory reaction in the airways
Results were presented as standardized mean differences (SMD) of quality-adjusted life years (QALY), life years (LY) gained, Costs, incremental cost-effectiveness ratios (ICER), incremental net monetary benefits (INMB), and incremental net health benefits (INHB)
The results indicate that triple therapy is cost-effective than dual therapy in moderate to severe chronic obstructive pulmonary disease (COPD) patients as it provides more QALY and LY but at an additional cost

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is an advancing pulmonary disorder distinguished by diminished airflow and enhanced chronic inflammatory reaction in the airways. The goal of COPD drug therapy is to diminish symptoms, boost exercise resistance and health condition, and reduce exacerbation recurrence. COPD costs colossal expenditures through drugs, clinician visits, hospitalizations, and emergency room visits and adversely affects the patient’s quality of life (Ehteshami-Afshar et al, 2016; Lopez-Campos et al, 2016). Various factors may affect the healthcare costs in COPD including but not limited to symptom severity and frequency and nature of exacerbations (Blasi et al, 2014; Iheanacho et al, 2020; Rutten-van Mölken and Lee, 2006; Toy et al, 2010). Apart from its economic strain, COPD decreases patient’s overall health status and negatively impacts the quality of life owing to high levels of anxiety and depression (SolerCataluna et al, 2016)

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