title: Economic evaluation of treating chronic obstructive pulmonary disease with inhaled corticosteroids and long-acting beta2-agonists in a health maintenance organization.
abstract: OBJECTIVE
  In light of recent results from observational studies showing prolonged survival in subjects taking long-acting beta2-agonists (LABA) and/or inhaled corticosteroids (ICS) for chronic obstructive pulmonary disease (COPD), we investigated their cost-effectiveness (CE).
  
  
  METHODS
  Costs and survival data were collected for a sample of members enrolled in a large Health Maintenance Organization in the United States. An observational study design was used to evaluate cumulative costs and health benefits of LABA, ICS, ICS+LABA, or comparison drugs. Survival was estimated using a parametric regression model. Costs were adjusted for censoring and prognostic factors. CE was evaluated over a time horizon of 36 months and the remaining lifetime of subjects.
  
  
  RESULTS
  Over 36 months, life expectancy and costs were: 2.4 years (95% confidence interval (CI): 2.3; 2.5) and $28,030 (CI: $23,400; $33,570) for not receiving ICS or LABA; 2.6 years (CI: 2.6; 2.7) and $35,170 (CI: $29,970; $40,620) for ICS alone; 2.6 years (CI: 2.5; 2.7) and $27,380 (CI: $21,780; $32,510) for LABA alone; and, 2.7 years (CI: 2.6; 2.8) and $33,780 (CI: $28,700; $39,440) for subjects treated with ICS+LABA. The lifetime analysis showed similar trends.
  
  
  CONCLUSIONS
  There is an acute need to find effective, life-extending treatments for persons with COPD. ICS, LABA or their combination represent promising treatment options and are currently being tested in randomized trials. If the impact on survival seen in these trials compares to that seen in observational studies, LABA and the combination treatment are likely to be cost-effective in the United States.
authors.affiliation: Oxford Outcomes Ltd., 450-688 West Hastings Street, Vancouver, BC, Canada.
authors.forename: Yves M
authors.initials: YM
authors.lastname: Gagnon
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Levy
authors.forename: Michael D
authors.initials: MD
authors.lastname: Spencer
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hurley
authors.forename: Floyd J
authors.initials: FJ
authors.lastname: Frost
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Mapel
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Briggs
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists