An economic assessment of inhaled formoterol dry powder versus ipratropium bromide pressurized metered dose inhaler in the treatment of chronic obstructive pulmonary disease

A New Method for Examining the Cost Savings of Reducing COPD Exacerbations

“…[38,48] Estimates of treatment costs have also ranged widely; some studies have not accounted for them at all, [19] and most published studies have used treatment costs per day that were less than half the current average retail price for inhaled controller medications in the US. [15][16][17][18][20][21][22][23][24][25][26][27][28][29] Many studies have described cost effectiveness in terms of cost per QALY gained, which adds another level of assumptions about the progression of COPD and the impact of exacerbations on quality of life. The incidences of exacerbations in our study populations were similar to those reported in most randomized clinical trials and prospective cohorts of COPD patients with moderate and severe COPD.…”

“…For example, many studies are based on secondary data collected in randomized clinical trials of highly selected cohorts, which exclude patients with unstable comorbid conditions that commonly affect COPD patients. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Another problem is that individual healthcare cost data are privileged information, so studies have often had to rely on patient interviews or make other uncertain assumptions about the cost and occurrence of exacerbations. Other reports have relied on retrospective comparisons of historical cohorts, which are highly susceptible to selection biases.…”

Cost Effectiveness of Pharmacological Maintenance Treatment for Chronic Obstructive Pulmonary Disease

“…There were 16 cost-effectiveness studies that used empirical analysis of clinical trial data of individual patients, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] 14 studies that used Markov modelling, [44][45][46][47][48][49][50][51][52][53][54][55][56][57] and eight that used empirical analysis based on observational data. [58][59][60][61][62][63][64][65] Two studies have used a different approach, such as extrapolating the resource use reduction that was obtained after meta-analyses of clinical trials.…”

“…[51,54] Five trial-based economic evaluations required patients to have at least one exacerbation per year before study entry. [32,35,38,42,43] A few modelling studies explicitly mentioned that they modelled a patient population with a history of frequent symptoms [44] or exacerbations. [52] The observational studies had a greater variability in patient populations studied.…”

“…Two studies included only drug costs, [44,58] seven included only exacerbation-related and drug costs, [41][42][43]51,55,62,64] one excluded study drug costs, [30] three included total healthcare costs irrespective of cause [59][60][61] and one included COPD-related costs plus allcause hospitalization costs. [39] Few studies included indirect costs of productivity loss, [34,35,40] or income loss.…”