[Cost-effectiveness analysis of tiotropium compared to ipratropium and salmeterol].
OBJECTIVE
The constant increase in health care costs, in a context of limited resources and the appearance of more costly though more effective drugs, justifies an assessment of the pharmacoeconomics of these drugs. The objective of this study was to evaluate the cost-effectiveness of one of the newest drugs for the treatment of chronic obstructive pulmonary disease (COPD)-tiotropium.


METHODS
A cost-effectiveness analysis (costs and outcomes) within the framework of the Spanish National Health System was done. The alternatives to tiotropium analyzed were ipratropium and salmeterol. Direct health care costs associated with hospital treatment were calculated. Forced expiratory volume in 1 second, quality of life (with the Saint George's Respiratory Questionnaire), dyspnea transitional index, mean stay in hospital, and exacerbations were the variables used to measure effectiveness. Values for these variables were taken from the main reviews and randomized clinical trials published for tiotropium.


RESULTS
For COPD patients, treatment with tiotropium leads to a greater reduction in exacerbations (37% compared to ipratropium and 25% compared to salmeterol 25%), and a reduction in the number of days in hospital (33% compared to ipratropium and 14% compared to salmeterol). Therefore, use of tiotropium could save ;100 000 for the current rates of admission and lengths of hospital stay in Spain.


CONCLUSIONS
Tiotropium was more effective than ipratropium and salmeterol as measured by objective clinical variables (forced expiratory volume in 1 second) and subjective ones (the Saint George's Respiratory Questionnaire and dyspnea transitional index). Hospital stays were shorter and exacerbations fewer with tiotropium. In all cases, tiotropium was more cost-effective than the alternatives, thus use of tiotropium could help hospitals to save money.
García Ruiz
A J
AJ
Unidad de Farmacoeconomía e IRS. Departamento de Farmacología y Terapéutica Clínica. Universidad de Málaga. Málaga. España. ajgr@uma.es
Leiva Fernández
F
F
Martos Crespo
F
F
D000328:Adult; D000368:Aged; D000420:Albuterol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D017048:Health Care Costs; D006801:Humans; D009241:Ipratropium / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics*; D000068299:Salmeterol Xinafoate; D012602:Scopolamine Derivatives / Q000191:economics* / Q000627:therapeutic use; D013030:Spain; D000069447:Tiotropium Bromide
D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000068299:Salmeterol Xinafoate; D009241:Ipratropium; D000420:Albuterol; D000069447:Tiotropium Bromide