title: Evaluation of COPD Treatments: A Multicriteria Decision Analysis of Aclidinium and Tiotropium in the United States.
abstract: Comparisons of the use of aclidinium bromide and tiotropium bromide for the treatment of chronic obstructive pulmonary disease often concentrate on key end points (exacerbations) at the expense of other benefits and risks. Multicriteria decision analysis (MCDA) can help overcome this by using stakeholder preferences to combine multiple end points into an overall value estimate.
  
  
  
  To evaluate the use of aclidinium bromide twice daily via Pressair™ (AstraZeneca Pharmaceuticals LP, Wilmington, DE) and of tiotropium once daily via HandiHaler®(Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT) from the perspective of patients using MCDA.
  
  
  
  Literature reviews and clinician engagement were used to identify value criteria. Performance of criteria was estimated from a clinical trial and clinician opinion. Scores and swing weights came from six clinicians who, during a 2-day workshop, reflected their patients' preferences. Scenario and sensitivity analyses were used to explore uncertainty in model designs and inputs.
  
  
  
  Fourteen criteria, covering clinical effectiveness, safety, and convenience of the treatments of chronic obstructive pulmonary disease, were identified. Exacerbations and device preloading were identified as the most important to patients; the least important was rescue medication use. Tiotropium's higher overall clinical effectiveness score was offset by aclidinium's better performance on safety and convenience outcomes. The MCDA generated a -42 (worst performance) to 100 (best performance) scale. The net impact of benefits over risks of aclidinium (38.5) exceeded that of tiotropium (13.2), and patients preferred aclidinium 79.7% of the time.
  
  
  
  When considering clinical benefits and risks, aclidinium and tiotropium generate similar value to patients, but when convenience criteria are considered, aclidinium may be preferred. Further work is required to replicate these results, including eliciting preferences directly from patients.
authors.affiliation: Evidera, London, UK. Electronic address: kevin.marsh@evidera.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.affiliation: Evidera, London, UK.
authors.forename: Erica
authors.initials: E
authors.lastname: Zaiser
authors.affiliation: Evidera, London, UK.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Orfanos
authors.affiliation: Evidera, London, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Salverda
authors.affiliation: Evidera, Boston, MA, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Wilcox
authors.affiliation: Forest Research Institute (an affiliate of Actavis, Inc.), Jersey City, NJ, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Sun
authors.affiliation: Forest Research Institute (an affiliate of Actavis, Inc.), Jersey City, NJ, USA.
authors.forename: Shailja
authors.initials: S
authors.lastname: Dixit
mesh_terms: D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005541:Forced Expiratory Volume; D006801:Humans; D009330:Nebulizers and Vaporizers; D057240:Patient Preference; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012720:Severity of Illness Index; D000069447:Tiotropium Bromide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014326:Tropanes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014481:United States
chemical_list: D001993:Bronchodilator Agents; D014326:Tropanes; C542859:aclidinium bromide; D000069447:Tiotropium Bromide
keywords: aclidinium; chronic obstructive pulmonary disease; multicriteria decision analysis; tiotropium