title: Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: a fully incremental analysis.
abstract: OBJECTIVE
  Frequent exacerbations which are both costly and potentially life-threatening are a major concern to patients with chronic obstructive pulmonary disease (COPD), despite the availability of several treatment options. This study aimed to assess the lifetime costs and outcomes associated with alternative treatment regimens for patients with severe COPD in the UK setting.
  
  
  METHODS
  A Markov cohort model was developed to predict lifetime costs, outcomes, and cost-effectiveness of various combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta agonist (LABA), an inhaled corticosteroid (ICS), and roflumilast in a fully incremental analysis. Patients willing and able to take ICS, and those refusing or intolerant to ICS were analyzed separately. Efficacy was expressed as relative rate ratios of COPD exacerbation associated with alternative treatment regimens, taken from a mixed treatment comparison. The analysis was conducted from the UK National Health Service (NHS) perspective. Parameter uncertainty was explored using one-way and probabilistic sensitivity analysis.
  
  
  RESULTS
  Based on the results of the fully incremental analysis a cost-effectiveness frontier was determined, indicating those treatment regimens which represent the most cost-effective use of NHS resources. For ICS-tolerant patients the cost-effectiveness frontier suggested LAMA as initial treatment. Where patients continue to exacerbate and additional therapy is required, LAMA + LABA/ICS can be a cost-effective option, followed by LAMA + LABA/ICS + roflumilast (incremental cost-effectiveness ratio [ICER] versus LAMA + LABA/ICS: £16,566 per quality-adjusted life-year [QALY] gained). The ICER in ICS-intolerant patients, comparing LAMA + LABA + roflumilast versus LAMA + LABA, was £13,764/QALY gained. The relative rate ratio of exacerbations was identified as the primary driver of cost-effectiveness.
  
  
  CONCLUSIONS
  The treatment algorithm recommended in UK clinical practice represents a cost-effective approach for the management of COPD. The addition of roflumilast to the standard of care regimens is a clinical and cost-effective treatment option for patients with severe COPD, who continue to exacerbate despite existing bronchodilator therapy.
authors.affiliation: IMS Consulting Group, London, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Hertel
authors.forename: Robert W
authors.initials: RW
authors.lastname: Kotchie
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Samyshkin
authors.forename: Matthew
authors.initials: M
authors.lastname: Radford
authors.forename: Samantha
authors.initials: S
authors.lastname: Humphreys
authors.forename: Kevin
authors.initials: K
authors.lastname: Jameson
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000191:economics / Q000627:therapeutic use; D000465:Algorithms; D000631:Aminopyridines / Q000191:economics / Q000627:therapeutic use; D001549:Benzamides / Q000191:economics / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes / Q000191:economics / Q000627:therapeutic use; D003661:Decision Support Techniques; D016527:Drug Costs; D004359:Drug Therapy, Combination; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D018727:Muscarinic Antagonists / Q000191:economics / Q000627:therapeutic use; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D058988:Phosphodiesterase 4 Inhibitors / Q000191:economics / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013222:State Medicine / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000631:Aminopyridines; D001549:Benzamides; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D018727:Muscarinic Antagonists; D058988:Phosphodiesterase 4 Inhibitors; C424423:Roflumilast