Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients.
Current practice guidelines for the treatment of COPD recommend the use of combined inhaled corticosteroids and long-acting bronchodilators in severe and very severe patients (GOLD stages III and IV). The aim of this study was to evaluate, through a simulation model, the economic consequences of this recommendation in Italy. We developed a cost-effectiveness analysis (CEA) on five alternative therapeutic strategies (salmeterol/fluticasone, SF; formoterol! budesonide, FB; salmeterol alone, S; fluticasone alone, F; control, C). Published data on the Italian COPD population and efficacy data from international reference trials were fitted in a disease progression model based on a Markov chain representing severity stages and death. The yearly total direct costs of treating COPD patients in Italy was estimated at approximately Euro 7 billion, with a mean cost per patient per year of around Euro 2450. Mean survival of the cohort is 11.5 years. The C and F strategies were dominated (ie, are associated with worse outcomes and higher costs) by all alternatives. SF and FB were the most effective strategies, with a slight clinical superiority of SF, but they were also marginally more expensive than S. Incremental cost-effectiveness of SF vs S was Euro 679.5 per avoided exacerbation and Euro 3.3 per symptom-free day. Compared with current practice, the recommended use of combined inhaled corticosteroids and long-acting bronchodilators for severe and very severe COPD patients has the potential for improving clinical outcomes without increasing healthcare costs.
Dal
Negro Roberto
NR
Lung Dept., Orlandi General Hospital, Bussolengo,Verona, Italy. rdalnegro@ulss22.ven.it
Eandi
M
M
Pradelli
L
L
Iannazzo
S
S
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D000420:Albuterol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D019819:Budesonide / Q000191:economics / Q000627:therapeutic use; D002017:Budgets; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000191:economics / Q000627:therapeutic use; D000068297:Fluticasone-Salmeterol Drug Combination; D000068759:Formoterol Fumarate; D019983:Guideline Adherence; D017048:Health Care Costs; D015276:Health Care Rationing / Q000191:economics*; D006801:Humans; D007558:Italy; D008390:Markov Chains; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D001993:Bronchodilator Agents; D004338:Drug Combinations; D004983:Ethanolamines; D000068297:Fluticasone-Salmeterol Drug Combination; D019819:Budesonide; D000420:Albuterol; D000068759:Formoterol Fumarate