Cost-effectiveness of inhaled corticosteroids for chronic obstructive pulmonary disease according to disease severity.
OBJECTIVE
Inhaled corticosteroids reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD), but their cost-effectiveness is not known.


METHODS
We used a Markov model to determine, from a societal perspective, the cost-effectiveness of four treatment strategies involving inhaled corticosteroids: no use regardless of COPD severity; use in all disease stages; use in patients with stage 2 or 3 disease (forced expiratory volume in 1 second [FEV(1)] <50% of predicted); and use in patients with stage 3 disease (FEV(1) <35% of predicted). Data from the literature were used to estimate mortality, exacerbation, and disease progression rates, as well as the costs associated with care and quality-adjusted life-years (QALYs), according to disease stage and use or nonuse of inhaled corticosteroids. A time horizon of 3 years was used.


RESULTS
Use of inhaled corticosteroids in patients with stage 2 or 3 disease was associated with a cost of 17,000 dollars per QALY gained. In stage 3 patients, use resulted in a cost of 11,100 dollars per QALY gained. Providing inhaled corticosteroids to all COPD patients was associated with a less favorable cost-effectiveness ratio. Results were robust to various assumptions in a Monte Carlo simulation.


CONCLUSIONS
In patients with COPD, use of inhaled corticosteroids in those with stage 2 or 3 disease for 3 years results in improved quality-adjusted life expectancy at a cost that is similar to that of other therapies commonly used in clinical practice.
Institute of Health Economics, Department of Medicine, University of Alberta, Edmonton, Canada. don.sin@ualberta.ca
Donald D
DD
Sin
Kamran
K
Golmohammadi
Philip
P
Jacobs
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005541:Forced Expiratory Volume; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000503:physiopathology; D019057:Quality-Adjusted Life Years
D000305:Adrenal Cortex Hormones