An economic analysis of pharmacological treatment of COPD in Spain

Miravitlles, Marc; Brosa, Max; Velasco, M. del Valle; Crespo, C.; Gobartt, Elena; Díaz, Silvia; González-Rojas, Núria

doi:10.1016/j.rmed.2008.11.019

Cited by 24 publications

(15 citation statements)

References 39 publications

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“…Although the potential drug savings are of the same order, the difference in average drug cost between our study and a previous analysis [Miravitlles et al 2009a] may be due to the fact that, in our case, 92.5% of patients had an FEV 1 above 50%…”

Section: Discussioncontrasting

confidence: 51%

“…To date, the only comparison made in our area between the GOLD recommendations and clinical practice looked at drug costs using a theoretical method [Miravitlles et al 2009a]. This study identified that the mean annual cost of drug treatment for a patient with COPD was €1218-1314 and the potential savings derived from adherence to the GOLD recommendations was on average between €198 and €293.…”

Section: Discussionmentioning

confidence: 99%

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Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting

Miravitlles

Sicras

Crespo

et al. 2013

Ther Adv Respir Dis

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Background: The aim of this study was to analyse the economic impact of nonadherence to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines in patients with chronic obstructive pulmonary disease (COPD). Methods: A retrospective analysis was carried out on a claim database. Patients aged at least 40 years with a diagnosis of COPD were eligible for this analysis. Demographics, medical data and use of resources were collected and direct and indirect costs were analysed (from January 2008 to June 2009). A probabilistic multivariate sensitivity analysis of avoided costs was carried out. All results are presented in annualized form and costs are expressed in Euros (2009). Results: A total of 1365 patients were included, 79.5% were men. The mean age (±standard deviation) was 71.4 (±10.3) years, the mean forced expiratory volume in 1 s (FEV 1) was 65.3% and they had a COPD history of 5.5 (±2.9) years. Patients were divided into an adherent group and a nonadherent group depending on whether therapeutic recommendations according to severity defined in the GOLD guidelines (2007) were followed. Patients in both groups were also classified as having stage II (FEV 1 < 80% and < 50%) or stage III disease (FEV 1 < 50% and ≥ 30%). The total annual drug cost per patient in the nonadherent group was €771.5 while it was only €426.4 for the adherent group. The average direct cost per patient per year in the nonadherent stage II group was €1465 (±971) and it rose to €2942 (±1918) for patients in the nonadherent group with stage III disease. The potential saving from the implementation of the GOLD guidelines in stage II COPD amounted to €758 per patient per year (68% saving on drug cost). In contrast, the cost for patients with stage III disease was higher in the adherent group versus the nonadherent group (€2468). Conclusions: The cost of COPD may vary according to compliance with the GOLD guidelines. The cost observed for patients with stage II disease is higher than expected in patients who adhere to treatment, but patients with stage III disease treated according to the GOLD guidelines had significantly higher treatment costs.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting

Miravitlles

Sicras

Crespo

et al. 2013

Ther Adv Respir Dis

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“…In addition, the demonstration of product value during drug development faces the limitations of clinical trial designs, which may lead to an underestimation of costs compared with what would occur in a more naturalistic setting, especially considering the small and highly selected fraction of the COPD patient population included in these trials [2,51]. Treatment guidelines in COPD are mainly based on evidence from the clinical trials conducted by the pharmaceutical industry.…”

Section: Economic Aspects Of Copd Pharmacological Treatmentsmentioning

confidence: 99%

Treatment of COPD: from pharmacological to instrumental therapies

Alifano¹,

Cuvelier²,

Delage³

et al. 2010

Eur Respir Rev

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T he two main goals of the current management of chronic obstructive pulmonary disease (COPD) are: 1) to reduce the impact of the disease on daily activities; and 2) to reduce the risk of future events (exacerbations, lung function decline and death) [1]. The first measure is obviously smoking cessation; however, we will not discuss this.Treatment guidelines are mainly based on randomised clinical trials that include a small and highly selected fraction of the COPD population [2]. Therefore, it is questionable as to whether these evidence-based guidelines can be extrapolated to the overall COPD population in the everyday practice. Indeed, less than one in five or 10 patients with COPD could fit into inclusion or exclusion criteria commonly used in clinical trials evaluating efficacy of pharmacological treatments [2,3]. In addition, COPD is a heterogeneous disease and patients with similar forced expiratory volume in 1 s (FEV1) may show very different functional status, underlying lung pathology and comorbidities. For most treatments, differences in the responsiveness of COPD subgroups are not yet established and large, long clinical trials, along with high-quality meta-analyses, remain the basis of the current treatment guidelines and the evaluation of the benefit/risk ratio of the main therapeutic classes used in COPD management. However, even the large therapeutic trials may suffer from methodological limitations in the design or analysis [4].The most important outcomes in clinical trials are patientcentred outcomes. Exacerbations, health-related quality of life and mortality are logical major outcomes in COPD trials [4]. In addition, exercise performance and lung function decline are other important targets for therapeutic intervention in COPD [5]. Lung function and biological markers reliably predicting individual response to treatments would be useful. PHARMACOLOGICAL INTERVENTIONS BronchodilatorsBronchodilators are the mainstay of the current pharmacological management of COPD. Long-acting bronchodilators reduce exacerbations and improve health-related quality of life [6][7][8][9][10][11]. The inconsistencies in the definitions or statistical analyses of exacerbations hamper comparison of efficacy data on this outcome between trials performed with different long-acting bronchodilators [4,12]. A clinical trial has been designed to compare the effect of tiotropium and salmeterol on exacerbations and would require the inclusion of 6,800 patients in order to potentially detect a difference in efficacy between the two long-acting bronchodilators [13]. The reduction of lung function decline by bronchodilators is a matter of debate [11]. A post hoc analysis of the TORCH study suggested that salmeterol reduces the rate of decline in post-bronchodilator FEV1 versus placebo [8]. A post hoc analysis of two 1-yr trials with tiotropium versus placebo also showed an improvement in the rate of decline of FEV1 [14]. Except in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II COPD [10], t...

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“…5 Numerous Spanish and international observational studies performed in different care settings have detected intensive use of ICs alone or combined with LABD in COPD patients. In Spain, several studies [6][7][8] have shown that over 60% of patients with mild COPD receive ICs (alone or in combination with LABDs), generally at high doses, irrespective of the care setting. This is in stark contrast with studies indicating that the mixed COPD-asthma phenotype is identified in less than 20% of patients, 9 and that only one third of patients are frequent exacerbators.…”

Section: Introductionmentioning

confidence: 99%

“Correct Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease”: A Consensus Document

Alcázar

Casanova

Miravitlles

et al. 2015

Archivos de Bronconeumología (English Edition)

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An economic analysis of pharmacological treatment of COPD in Spain

Abstract: Treatment of COPD allows for the identification of areas of inefficiency. An improvement in the adherence to the GOLD guidelines would imply potential savings of medication costs of about 20% of the observed costs.

Cited by 24 publications

References 39 publications

Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting

Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting

Treatment of COPD: from pharmacological to instrumental therapies

“Correct Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease”: A Consensus Document

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