Cost-effectiveness of salmeterol, fluticasone, and combination therapy for COPD.
OBJECTIVE
To assess the incremental cost-effectiveness of inhaled medication use in chronic obstructive pulmonary disease (COPD).


METHODS
A Markov model was constructed to estimate the incremental quality-adjusted life-years (QALYs) gained of the alternative treatment arms used in the Towards a Revolution in COPD Health (TORCH) study (ie, salmeterol-fluticasone propionate combination [SFC], salmeterol, fluticasone, and placebo).


METHODS
The cycle length for the model was set to 3 months, and the maximum time horizon was set to 3 years. The cost-effective analysis was conducted from a third-party payer's perspective in the US healthcare system. Future costs and effects were discounted at 3%. Multiple 1-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were performed to handle uncertainty.


RESULTS
The most cost-effective strategies are placebo (as-needed short-acting bronchodilator use with no maintenance therapy) when willingness to pay (WTP) is less than $52,800/QALY gained and SFC when WTP exceeds that threshold. When no maintenance therapy is not an acceptable option, the most cost-effective strategies are treatment with salmeterol when WTP is less than $49,500/QALY gained and treatment with SFC when WTP exceeds that threshold. The base-case analysis showed that incremental cost-effectiveness ratios of salmeterol, fluticasone, and SFC relative to placebo were $56,519, $62,833, and $52,046/QALY gained, respectively.


CONCLUSIONS
The most cost-effective strategy in moderate-to-severe COPD depends on how much society is willing to pay to achieve health improvements. When treatment with as-needed short-acting bronchodilator use does not provide adequate control, salmeterol or SFC would be the drug of choice depending on WTP.
Oba
Yuji
Y
Department of Pulmonary, Critical Care and Environmental Medicine, University of Missouri-Columbia, One Hospital Dr, Health Science Center MA419A, Columbia, MO 65212, USA. obay@health.missouri.edu
D000368:Aged; D000420:Albuterol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000730:Androstadienes / Q000191:economics* / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D000068299:Salmeterol Xinafoate
D000730:Androstadienes; D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol