Cost-Effectiveness of Glycopyrronium Bromide Compared with Tiotropium in Patients with Chronic Obstructive Pulmonary Disease in Sweden.
OBJECTIVE
The objective of this study was to compare the cost effectiveness of once-daily Seebri Breezhaler(®) (glycopyrronium bromide) 50 µg with Spiriva(®) (tiotropium bromide) 18 µg in the maintenance treatment of chronic obstructive pulmonary disease (COPD) in the Swedish setting.


METHODS
A previously published COPD Markov model accounting for disease progression and treatment discontinuation was used. Disease progression included the annual decline in forced expiratory volume in the first second (FEV1) and occurrence of any exacerbations. Efficacy in the model consisted of FEV1 improvement between baseline and 12 weeks and the annual risk ratio of having an exacerbation compared to placebo. These clinical efficacy inputs were derived from a 1-year head-to-head trial comparing glycopyrronium 50 µg to tiotropium 18 µg. Utility values and cost estimates were obtained from the literature. The base-case analysis was performed for a 3-year time horizon. Cost and effects were discounted with 3% in accordance to Swedish guidelines. Uncertainty was assessed by one-way and probabilistic sensitivity analyses.


RESULTS
Glycopyrronium was found to be less costly and more effective than tiotropium in moderate to severe COPD patients with cost savings of 5197 Swedish kronor (€570, US$725) per patient over a 3-year time horizon. The probabilistic sensitivity analysis indicated that over 99% of the iterations produced dominant results for glycopyrronium.


CONCLUSIONS
Glycopyrronium bromide 50 µg once daily can be considered a cost effective alternative to tiotropium bromide 18 µg once daily in the maintenance treatment of COPD patients in Sweden.
Novartis Pharma AB, Täby, Box 1150, 183 79, Stockholm, Sweden. madlaina.costa-scharplatz@novartis.com.
Madlaina
M
Costa-Scharplatz
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
Björn
B
Ställberg
Novartis Pharma AG, Basel, Switzerland.
Pankaj
P
Goyal
IMS Health, London, UK.
Yumi
Y
Asukai
Novartis Pharma AG, Basel, Switzerland.
Jean-Bernard
JB
Gruenberger
Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
David
D
Price
D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005541:Forced Expiratory Volume; D006024:Glycopyrrolate / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000191:economics* / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D013548:Sweden; D000069447:Tiotropium Bromide / Q000191:economics* / Q000627:therapeutic use*
D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D006024:Glycopyrrolate; D000069447:Tiotropium Bromide