title: Cost-effectiveness of roflumilast in combination with bronchodilator therapies in patients with severe and very severe COPD in Switzerland.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) represents a burden on patients and health systems. Roflumilast, an oral, selective phosphodiesterase-4-inhibitor reduces exacerbations and improves lung function in severe/very severe COPD patients with a history of exacerbations. This study aimed to estimate the lifetime cost and outcomes of roflumilast added-on to commonly used COPD regimens in Switzerland.
  
  
  METHODS
  A Markov cohort model was developed to simulate COPD progression in patients with disease states of severe, very severe COPD, and death. The exacerbation rate was assumed to be two per year in severe COPD. COPD progression rates were drawn from the published literature. Efficacy was expressed as relative ratios of exacerbation rates associated with roflumilast, derived from a mixed-treatment comparison. A cost-effectiveness analysis was conducted for roflumilast added to long-acting muscarinic antagonists (LAMA), long-acting β2-agonist/ inhaled corticosteroids (LABA/ICS), and LAMA + LABA/ICS. The analysis was conducted from the Swiss payer perspective, with costs and outcomes discounted at 2.5% annually. Parameter uncertainties were explored in one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  In each of the comparator regimens mean life expectancy was 9.28 years and quality-adjusted life years (QALYs) gained were 6.19. Mean estimated lifetime costs per patient in the comparator arms were CHF 83,364 (LAMA), CHF 88,161 (LABA/ICS), and CHF 95,564 (LAMA + LABA/ICS) respectively. Adding roflumilast resulted in a mean cost per patient per lifetime of CHF 86,754 (LAMA + roflumilast), CHF 91,470 (LABA/ICS + roflumilast), and CHF 99,364 (LAMA + LABA/ICS + roflumilast), respectively. Life-expectancy and quality-adjusted life-expectancy were 9.63 years and 6.47 QALYs (LAMA + roflumilast), 9.64 years and 6.48 QALYs (LABA/ICS + roflumilast), and 9.63 years and 6.47 QALYs (LAMA + LABA/ ICS + roflumilast). Incremental cost-effectiveness ratios were CHF 12,313, CHF 11,456, and CHF 13,671 per QALY when roflumilast was added to the three regimens.
  
  
  CONCLUSIONS
  Treatment with roflumilast is estimated to reduce the health and economic burden of COPD exacerbations and represent a cost-effective treatment option for patients with frequent exacerbations in Switzerland.
authors: IMS Health, Health Economics and Outcomes Research, London, United Kingdom. ysamyshkin@uk.imshealth.com
authors: Yevgeniy
authors: Y
authors: Samyshkin
authors: Michael
authors: M
authors: Schlunegger
authors: Susan
authors: S
authors: Haefliger
authors: Sabine
authors: S
authors: Ledderhose
authors: Matthew
authors: M
authors: Radford
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000191:economics* / Q000627:therapeutic use; D000631:Aminopyridines / Q000191:economics* / Q000627:therapeutic use; D001549:Benzamides / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes / Q000191:economics / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000191:economics* / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D018727:Muscarinic Antagonists / Q000191:economics* / Q000627:therapeutic use; D058988:Phosphodiesterase 4 Inhibitors / Q000191:economics* / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013557:Switzerland
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000631:Aminopyridines; D001549:Benzamides; D003521:Cyclopropanes; D005938:Glucocorticoids; D018727:Muscarinic Antagonists; D058988:Phosphodiesterase 4 Inhibitors; C424423:Roflumilast
keywords: COPD; cost-effectiveness; economic; exacerbations; modeling; treatment
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