Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium–olodaterol for patients with COPD in the Netherlands

Abstract

PurposeThe fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol showed increased effectiveness regarding lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with the use of its mono-components. Yet, while effectiveness and safety have been shown, the health economic implication of this treatment is still unknown. The aim of this study was to assess the cost–utility and budget impact of tiotropium–olodaterol FDC in patients with moderate to very severe COPD in the Netherlands.Patients and methodsA cost–utility study was performed, using an individual-level Markov model. To populate the model, individual patient-level data (age, height, sex, COPD duration, baseline forced expiratory volume in 1 second) were obtained from the tiotropium–olodaterol TOnado trial. In the model, forced expiratory volume in 1 second and patient-level data were extrapolated to utility and survival, and treatment with tiotropium–olodaterol FDC was compared with tiotropium. Cost–utility analysis was performed from the Dutch health care payer’s perspective using a 15-year time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%). Both univariate and probabilistic sensitivity analyses were performed. Budget impact was annually assessed over a 5-year time horizon, taking into account different levels of medication adherence.ResultsAs a result of cost increases, combined with quality-adjusted life-year (QALY) gains, results showed that tiotropium–olodaterol FDC had an incremental cost-effectiveness ratio of €7,004/QALY. Without discounting, the incremental cost-effectiveness ratio was €5,981/QALY. Results were robust in univariate and probabilistic sensitivity analyses. Budget impact was estimated at €4.3 million over 5 years assuming 100% medication adherence. Scenarios with 40%, 60%, and 80% adherence resulted in lower 5-year incremental cost increases of €1.7, €2.6, and €3.4 million, respectively.ConclusionTiotropium–olodaterol FDC can be considered a cost-effective treatment under current Dutch cost-effectiveness thresholds.

Indacaterol/glycopyrronium is cost-effective compared to salmeterol/fluticasone in COPD: FLAME-based modelling in a Swedish population

“…Results of this study are in line with the previously conducted CEA in the Swedish setting, which suggested that IND/GLY is associated with cost savings and is more effective than SFC in moderate to severe COPD patients with no history of exacerbations [ 13 ]. Recent studies have also demonstrated cost-effectiveness of dual bronchodilators over monotherapies in patients with COPD [ 31 , 32 ].…”

Clinical and economic evaluation of using fixed dose dual bronchodilator combination tiotropiumolodaterol in patients with chronic obstructive pulmonary disease

“…Фармакоэкономическая оценка препарата Спиолто Респимат при применении у больных с ХОБЛ была проведена в ряде европейских стран [18][19][20]. Во всех представленных исследованиях проводился анализ «затраты -эффективность» с помощью модели Маркова.…”

“…В исследовании, проводимом в Италии, затраты и показатели эффективности дисконтировались по дисконтной ставке 3% [18]; в исследовании, проводимом в Нидерландах, затраты дисконтировались по ставке 4%, показатели эффективности -по ставке 1,5% [19]; в исследовании, проводимом в Великобритании, ставка дисконтирования составила 3,5% как для затрат, так и для показателей эффективности [20].…”

<p>Modelling the Cost-Effectiveness of Indacaterol/Glycopyrronium versus Salmeterol/Fluticasone Using a Novel Markov Exacerbation-Based Approach</p>

“…Many of these studies have utilized a Markov model, whereby individual patients or cohorts of patients progress through different disease states over a series of successive cycles. [10][11][12][13][14][15] Typically, decline in lung function (FEV 1 ) has been used to model changes in disease severity or natural disease progression. However, by modelling only changes in airflow limitation, these studies have limited ability to fully estimate costs and health benefits, as many other factors (eg exacerbations) will influence patient outcomes.…”