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. 2008 Nov-Dec;15(8):437-43.
doi: 10.1155/2008/257618.

Cost-effectiveness of combination therapy for chronic obstructive pulmonary disease

Anderson Chuck  1 , Philip Jacobs, Irvin Mayers, Darcy Marciniuk
Affiliations

Cost-effectiveness of combination therapy for chronic obstructive pulmonary disease

Anderson Chuck et al. Can Respir J. 2008 Nov-Dec.

Abstract
in English, French

Background: There is evidence that combination therapy (CT) in the form of long-acting beta(2)-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).

Objective: To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.

Methods: A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV(1)] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV(1) less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality- adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.

Results: CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.

Conclusion: Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV(1) worsens and reaches 50% of predicted values, CT is recommended.

HISTORIQUE :: Selon certaines données probantes, la polythérapie sous forme de bêta2-agonistes à action prolongée (BAAP) et de corticoïdes par aérosol peut améliorer la fonction pulmonaire des patients atteints d’une maladie pulmonaire obstructive chronique (MPOC).

OBJECTIF :: Déterminer le rapport coût-efficacité de l’utilisation de la polythérapie chez aucun patient atteint de MPOC, tous les patients atteints de MPOC ou certains de ces patients.

MÉTHODOLOGIE :: Les auteurs ont conçu un modèle de Markov pour comparer quatre stratégies de traitement : ne pas recourir à la polythérapie, quelle que soit la gravité de la maladie (les patients ne reçoivent que des BAAP), recourir à la polythérapie seulement chez les patients atteints d’une MPOC de phase 3 (volume expiratoire maximal par seconde [VEMS] inférieur à 35 % de celui prévu), utilisation de la polythérapie seulement en présence d’une maladie de phase 2 ou 3 (VEMS inférieur à 50 % de celui prévu) et recourir à la polythérapie chez tous les patients quelle que soit la gravité de la MPOC. Les auteurs ont dérivé des publications les estimations des taux de mortalité, d’exacerbation et d’évolution du diagnostic, les années de vie pondérée par la qualité (AVPQ) et les coûts. Ils ont utilisé un horizon prévisionnel de trois ans et d’une vie entière. Ils ont effectué l’analyse selon la perspective du système de santé.

RÉSULTATS :: La polythérapie s’associe à un coût de 39 000 $ par AVPQ si elle est administrée aux patients atteints de la maladie de phase trois, de 47 500 $ par AVPQ si elle est administrée aux patients atteints de la maladie de phase 2 ou 3, et de 450 333 $ par AVPQ si elle est administrée à tous les patients atteints d’une MPOC. Les résultats résistaient à diverses hypothèses vérifiées dans une simulation de Monte Carlo.

CONCLUSION :: L’administration d’une polythérapie aux patients atteints d’une MPOC de phase 2 ou 3 est rentable. Le message à transmettre aux médecins de famille et aux spécialistes, c’est que lorsque le VEMS s’aggrave et atteint 50 %, la polythérapie est recommandée.

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Figures

Figure 1)
Figure 1)
Acceptability curve for a three-year model, constructed from 100,000 sample sets generated from a Monte Carlo simulation. Using long-acting beta2-agonist (LABA) monotherapy as the comparator, the curve depicts the proportion of incremental cost-effectiveness ratio from strategies using combination therapy (CT) that were below a range of cost per quality-adjusted life year (QALY) thresholds. Therefore, the curve represents the probability that CT is cost-effective (compared with LABA monotherapy) at particular cost per QALY thresholds
Figure 2)
Figure 2)
Model A represents the economic model describing combination therapy (CT) versus long-acting beta2-agonist (LABA) monotherapy based on three trials using a forced expiratory volume in 1 s (FEV1) of less than 50% predicted as the cut-off for stage 2 chronic obstructive pulmonary disease (COPD) (17,19,20). Model B uses the identical economic model but clinical outcomes from the Towards a Revolution in COPD Health (TORCH) trial (18) are included with the previous three studies. The FEV1 cut-off for stage 2 COPD was less than 60% predicted and therefore patients with milder COPD are included in this analysis. Note that that model is weighted according to patient numbers in each study and therefore model B is heavily weighted toward clinical outcomes of TORCH. QALY Quality-adjusted life year
See this image and copyright information in PMC

References

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