Abstract
Chronic obstructive pulmonary disease (COPD) guidelines advocate treatment with combinations of long-acting bronchodilators for COPD patients that have persistent symptoms or continue to have exacerbations while using a single bronchodilator. This study assessed the cost-effectiveness of the fixed dose combination of the bronchodilators tiotropium and olodaterol (TIO+OLO) versus two comparators (tiotropium monotherapy (TIO) and long-acting beta agonist/ inhaled corticosteroid (LABA/ICS) combinations) in three different countries: Finland (FI), Sweden (SE) and The Netherlands (NL). A previously published COPD patient-level discrete event simulation model was used to estimate effects and costs for 2,000 patients receiving either TIO+OLO, TIO monotherapy or LABA/ICS. Efficacy data for TIO+OLO versus TIO were obtained from a post-hoc analysis of the TONADO and DYNAGITO trials, while efficacy versus LABA/ICS was obtained from a Cochrane review. Treatment effects modelled included impact on FEV1, total and severe exacerbations, and pneumonias. The unit costs of medication, maintenance treatment, exacerbations and pneumonias were obtained from each of the three countries. The main outcomes were the lifetime quality-adjusted life-years (QALYs) and costs. Analyses adhered to the recommendations in the Finnish, Swedish and Dutch pharmacoeconomic guidelines. Treatment with TIO+OLO resulted in a gain in discounted QALYs of 0.09 (FI/SE) to 0.11 (NL) versus TIO and 0.23 (FI/SE) to 0.28 (NL) versus LABA/ICS. The incremental cost-effectiveness ratio of TIO+OLO in Finland was €11,300/QALY versus TIO and dominant versus LABA/ICS (payer perspective). For Sweden the ratios were €4,600/QALY and dominant, respectively (societal perspective). For The Netherlands the ratios were €14,400 and €9,200, respectively (societal perspective). TIO+OLO is a cost-effective option versus TIO in all three countries. Compared with LABA/ICS, TIO+OLO is cost-effective in the Netherlands and dominant in Sweden and Finland.
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