Economic evaluation of treating chronic obstructive pulmonary disease with inhaled corticosteroids and long-acting beta2-agonists in a health maintenance organization.
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.
Gagnon
Yves M
YM
Oxford Outcomes Ltd., 450-688 West Hastings Street, Vancouver, BC, Canada.
Levy
Adrian R
AR
Spencer
Michael D
MD
Hurley
Judith S
JS
Frost
Floyd J
FJ
Mapel
Douglas W
DW
Briggs
Andrew H
AH
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
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists