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.
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
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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