title: Evaluating the pharmacoeconomic effect of adding tiotropium bromide to the management of chronic obstructive pulmonary disease patients in Singapore.
abstract: OBJECTIVE
  To perform a pharmacoeconomic analysis on the treatment of chronic obstructive pulmonary disease (COPD) with the addition of tiotropium bromide.
  
  
  METHODS
  Pharmacoeconomic modeling was performed utilizing the efficacy of tiotropium bromide from the literature on different settings and severity of COPD. Reductions in exacerbations, hospitalizations, and number of exacerbation days per year were derived from these studies. Cost of drug treatment, exacerbations, hospitalization, and loss of income were derived from local data in Singapore and reported in Singapore dollars (US$1=S$1.71). A model was constructed to calculate the impact of one-year treatment with tiotropium bromide, and the results were reported for the total incremental cost per year, cost per year needed to reduce one hospitalization in one year, and cost-savings from hospitalizations in one year. Sensitivity analysis were performed for different number of patients treated per year, differing cost of hospitalization, different cost for tiotropium bromide, different impact of tiotropium bromide on clinical outcomes, and the different amount of substitution drug utilized in the comparator group.
  
  
  RESULTS
  Using the different clinical effects and looking at the impact on treating 1000, 2000, and 10,000 patients per year, most of the results showed a high level of decrease in overall cost per year that ranged from S$145.40 to S$840.37 per patient treated. Cost per year needed to reduce one hospitalization in one year ranged from S$3217.31 to S$18,148.92. Cost-savings from hospitalizations in one year per patient treated ranged from $57.16 to $322.49. This may contribute as high as 83% of the overall cost saving. Sensitivity analysis supports the cost savings finding.
  
  
  CONCLUSIONS
  Adding tiotropium bromide for severe COPD patients would lead to a significant cost savings for the economy.
authors.affiliation: Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. mdcleekh@nus.edu.sg
authors.forename: Kang-Hoe
authors.initials: KH
authors.lastname: Lee
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.forename: Tow-Keang
authors.initials: TK
authors.lastname: Lim
mesh_terms: D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D017281:Cost of Illness; D017850:Economics, Pharmaceutical; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D009241:Ipratropium / Q000191:economics / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012602:Scopolamine Derivatives / Q000191:economics / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000069447:Tiotropium Bromide