title: Cost-effectiveness of pharmacotherapy for COPD in ambulatory care: a review.
abstract: OBJECTIVE
  This article conducts a literature review about the cost-effectiveness of pharmacotherapy for chronic obstructive pulmonary disease (COPD) in ambulatory care.
  
  
  METHODS
  Relevant economic evaluations were identified by searching Medline (PubMed) and the National Health Service (NHS) Economic Evaluation Database. The search strategy focused on literature reviews and primary economic evaluations. Economic evaluations were included, which compared pharmacotherapy for COPD, chronic bronchitis or pulmonary emphysema with an alternative in terms of costs and health outcomes.
  
  
  RESULTS
  The majority of economic evaluations show that pharmacotherapy for COPD in ambulatory care is cost-effective. Cost-effectiveness derives from an improvement in lung function and a reduction in the number of exacerbations, which translates into cost savings from fewer hospitalizations. Pharmacotherapy also tends to be more cost-effective in patients with more severe COPD. When applying these results to a specific country or setting, the cost-effectiveness of pharmacotherapy will depend on the distribution of COPD severity among patients, the alternative with which pharmacotherapy is compared, the impact of pharmacotherapy on exacerbations, costs and treatment patterns of exacerbations, and price of pharmacotherapy. Economic evaluations tended to suffer from short-time horizons, restricted scope of included costs and use of various health outcome measures.
  
  
  CONCLUSIONS
  There is a case to be made in favour of economic evaluations from the societal perspective that are based on a decision-analytic model to allow for extrapolation beyond the duration of clinical trials and that use generic health outcome measures such as quality-adjusted life years.
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
mesh_terms: D000553:Ambulatory Care; D029481:Bronchitis, Chronic / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006296:Health Services / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D011656:Pulmonary Emphysema / Q000188:drug therapy; D012129:Respiratory Function Tests
chemical_list: D001993:Bronchodilator Agents
keywords: ambulatory care; chronic obstructive pulmonary disease; cost-effectiveness; economic evaluation; medicines