title: Cost-effectiveness of umeclidinium/vilanterol combination therapy compared to tiotropium monotherapy among symptomatic patients with chronic obstructive pulmonary disease in the UK.
abstract: BACKGROUND
  The cost-effectiveness of umeclidinium bromide-vilanterol (UMEC/VI) versus tiotropium monotherapy in the UK was assessed using a UMEC/VI treatment-specific economic model based on a chronic obstructive pulmonary disease (COPD) disease-progression model.
  
  
  METHODS
  The model was implemented as a linked-equation model to estimate COPD progression and associated health service costs, and its impact on quality-adjusted life years (QALYs) and survival. Statistical risk equations for clinical endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. For the selected timeframe (1-40 years) and probabilistic analysis, model outputs included disaggregated costs, total costs, exacerbations, life-years and QALYs gained, and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  Random-effects meta-analysis of tiotropium comparator trials estimated treatment effect of UMEC/VI as 92.17 mL (95 % confidence interval: 61.52, 122.82) in forced expiratory volume in 1 s. With this benefit, UMEC/VI resulted in an estimated annual exacerbation reduction of 0.04 exacerbations/patient and 0.36 life years gained compared to tiotropium over patient lifetime. With an additional 0.18 QALYs/patient and an additional lifetime cost of £372/patient at price parity, the incremental cost effectiveness ratio (ICER) of UMEC/VI compared to tiotropium was £2088/QALY. This ICER increased to £17,541/QALY when price of UMEC/VI was increased to that of indacaterol plus tiotropium in separate inhalers. The ICER improved when model duration was reduced from patient lifetime to 1 or 5 years, or when treatment effect was assumed to last for 12 months following treatment initiation.
  
  
  CONCLUSIONS
  UMEC/VI can be considered a cost-effective alternative to tiotropium at a certain price.
authors.affiliation: Value Evidence and Outcomes, GlaxoSmithKline R&D, Stockley Park, Uxbridge, UB11 1BT UK.
authors.forename: Yogesh Suresh
authors.initials: YS
authors.lastname: Punekar
authors.affiliation: Double Helix Consulting, London, W1U 6TQ UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Roberts
authors.affiliation: Value Evidence and Outcomes, GlaxoSmithKline R&D, RTP, Durham, NC 27709-3398 USA ; Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8S 4L8 Canada.
authors.forename: Afisi
authors.initials: A
authors.lastname: Ismaila
authors.affiliation: Double Helix Consulting, London, W1U 6TQ UK.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Leary
keywords: Chronic obstructive pulmonary disease; Cost-effectiveness; Tiotropium; Umeclidinium/vilanterol