title: Cost effectiveness of tiotropium in patients with asthma poorly controlled on inhaled glucocorticosteroids and long-acting β-agonists.
abstract: BACKGROUND
  A considerable proportion of patients with asthma remain uncontrolled or symptomatic despite treatment with a high dose of inhaled glucocorticosteroids (ICSs) and long-acting β2-agonists (LABAs). Tiotropium Respimat(®) added to usual care improves lung function, asthma control, and the frequency of non-severe and severe exacerbations, in a population of adult asthma patients who are uncontrolled despite treatment with ICS/LABA.
  
  
  OBJECTIVE
  This study estimated the cost effectiveness of tiotropium therapy as add-on to usual care in asthma patients that are uncontrolled despite treatment with ICS/LABA combination from the perspective of the UK National Health Service (NHS).
  
  
  METHODS
  A Markov model was developed which considers levels of asthma control and exacerbations. The model analysed cost and quality-adjusted life-years (QALYs); sensitivity and scenario analyses were also conducted to test the robustness of the base case outcomes. All costs are given at 2012 prices.
  
  
  RESULTS
  The model found that in this category of asthma with unmet need, add-on tiotropium therapy generated an incremental 0.24 QALYs and £5,238 costs over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of £21,906 per QALY gained. Sensitivity analysis suggested that findings were most dependent on the costs of managing uncontrolled asthma and the cost of treatment with tiotropium.
  
  
  CONCLUSIONS
  In this modelled analysis of two clinical trials, tiotropium was found to be cost effective when added to usual care in patients who remain uncontrolled despite treatment with high-dose ICS/LABA. Further research should investigate the long-term treatment effectiveness of tiotropium.
authors: Health Economics and Outcomes Research, Real-World Evidence Solutions, IMS Health, 210 Pentonville Road, London, N1 9JY, UK.
authors: Jenny
authors: J
authors: Willson
authors: Eric D
authors: ED
authors: Bateman
authors: Ian
authors: I
authors: Pavord
authors: Adam
authors: A
authors: Lloyd
authors: Tania
authors: T
authors: Krivasi
authors: Dirk
authors: D
authors: Esser
mesh_terms: D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012138:Respiratory Therapy; D012602:Scopolamine Derivatives / Q000191:economics* / Q000627:therapeutic use; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide