title: Cost-effectiveness of combination therapy for chronic obstructive pulmonary disease.
abstract: BACKGROUND
  There is evidence that combination therapy (CT) in the form of long-acting beta(2)-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).
  
  
  OBJECTIVE
  To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.
  
  
  METHODS
  A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV(1)] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV(1) less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality- adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.
  
  
  RESULTS
  CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.
  
  
  CONCLUSIONS
  Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV(1) worsens and reaches 50% of predicted values, CT is recommended.
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
authors.forename: Anderson
authors.initials: A
authors.lastname: Chuck
authors.forename: Philip
authors.initials: P
authors.lastname: Jacobs
authors.forename: Irvin
authors.initials: I
authors.lastname: Mayers
authors.forename: Darcy
authors.initials: D
authors.lastname: Marciniuk
mesh_terms: D000368:Aged; D000420:Albuterol / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005541:Forced Expiratory Volume; D000068759:Formoterol Fumarate; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D000068299:Salmeterol Xinafoate; D014481:United States
chemical_list: D001993:Bronchodilator Agents; D004983:Ethanolamines; D000068299:Salmeterol Xinafoate; D000420:Albuterol; D000068759:Formoterol Fumarate