title: Cost-utility analysis of tiotropium versus usual care in patients with COPD in the UK and Belgium.
abstract: OBJECTIVE
  To evaluate the cost-utility of adding tiotropium to usual care versus usual care alone for patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in the UK and Belgium.
  
  
  METHODS
  A four-state Markov model was developed with three disease severity states (moderate, severe, very severe) and death. Severity was based on post-bronchodilator FEV₁ and transitions were based on outcomes of the Understanding Potential Long Term Impacts on Function with Tiotropium (UPLIFT®) trial. Utilities were derived from EQ-5D scores for a subset of UPLIFT® patients. UK costs were evaluated separately for England (E), and for Scotland, Wales and Northern Ireland (SWNI). Belgian (B) costs were obtained from local sources. Uncertainty was assessed by deterministic and probabilistic sensitivity analysis (PSA).
  
  
  RESULTS
  Adding tiotropium to usual care resulted in an incremental cost per patient of €969 (B), £796 (E), and £812 (SWNI), and incremental QALYs of 0.052 (B), and 0.051 (E, SWNI). The four-year incremental cost-effectiveness ratios (ICER) were €18,617 (B), £15,567 (E) and £15,890 (SWNI) per QALY. Probability of tiotropium being cost-effective at £30,000 (€50,000) per QALY gained was greater than 60%.
  
  
  CONCLUSIONS
  At willingness to pay thresholds of £(€) 30,000 per QALY gained, adding tiotropium to usual care is cost-effective.
authors.affiliation: Health Economic Modelling Unit, HERON Evidence Development Ltd., Building 210a, Butterfield Technology and Business Park, Stopsley, Luton LU2 8DL, UK. robert.hettle@heronhealth.com
authors.forename: Robert
authors.initials: R
authors.lastname: Hettle
authors.forename: Hanne
authors.initials: H
authors.lastname: Wouters
authors.forename: Jon
authors.initials: J
authors.lastname: Ayres
authors.forename: Ray
authors.initials: R
authors.lastname: Gani
authors.forename: Steve
authors.initials: S
authors.lastname: Kelly
authors.forename: Michaela
authors.initials: M
authors.lastname: Lion
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
mesh_terms: D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012602:Scopolamine Derivatives / Q000191:economics* / Q000627:therapeutic use; D012720:Severity of Illness Index; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide