Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients

Abstract

PurposeUmeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective.MethodsA previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms measured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observational study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed.ResultsUMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY.ConclusionUMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective.

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

“… 47 These approaches have limitations in that the probability of exacerbations is not affected by having experienced a previous exacerbation, while a history of exacerbations has been shown to be the most reliable predictor for future exacerbations. 19 , 23 Yet, some potential limitations have to be noted. In the cost-effectiveness analyses, adverse events from bronchodilators were not incorporated, although these side effects are considered of only minor importance and likely to be equally prevalent among comparators.…”

“…22 In addition, tiotropium has been used as comparator in a previous economic study that evaluated the cost-effectiveness of another FDC LABA–LAMA. 23 …”

Fixed‐dose combination of umeclidinium and vilanterol for patients with chronic obstructive pulmonary disease: A systematic review

“…These results suggest that umeclidinium/vilanterol treatment would be dominant compared with tiotropium and no long‐acting bronchodilator treatment, and less costly than open‐dual LAMA + LABA treatment in patients with moderate to very severe COPD …”

“…Fewer exacerbations were predicted to occur with umeclidinium/vilanterol treatment compared with no long‐acting bronchodilator treatment. In a study using a cohort model based on the epidemiological longitudinal study ECLIPSE, umeclidinium/vilanterol 62.5 mcg/25 mcg (ANORO) produced additional 0.03 QALY (quality‐adjusted life year: a generic measure of https://en.wikipedia.org/wiki/Disease_burden, including both the quality and the quantity of life lived; where one QALY equates to 1 year in perfect health) and €590 vs Tiotropium …”

The cost-effectiveness of physical activity in the management of COPD patients in the UK

“…7 However, recently COPD disease statistical models demonstrated the interdependence between predictors and outcomes of the disease. [8][9][10][11][12] As Markov models are "memoryless," they are limited in their ability to deal simultaneously and accurately with the complex dependencies between patient risk factors, clinical events, and intervention benefits. To overcome this complexity, a combined Markov microsimulation model was constructed in MS Excel to predict the CE of PA.…”