title: Cost-effectiveness analysis of umeclidinium/vilanterol for the management of patients with moderate to very severe COPD using an economic model.
abstract: BACKGROUND
  Bronchodilators such as long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) are central to the pharmacological management of COPD. Dual bronchodilation with umeclidinium/vilanterol (UMEC/VI; 62.5/25 μg) is a novel LAMA/LABA combination approved for maintenance treatment for patients with COPD.
  
  
  OBJECTIVE
  The objective of this study was to assess the cost-effectiveness of maintenance treatment with UMEC/VI compared with tiotropium (TIO) 18 μg, open dual LAMA + LABA treatment, or no long-acting bronchodilator treatment in patients with moderate to very severe COPD.
  
  
  METHODS
  A Markov model was developed to estimate the costs and outcomes associated with UMEC/VI treatment in patients with moderate to very severe COPD (GSK study number: HO-13-13411). Clinical efficacy, costs, utilities, and mortality obtained from the published literature were used as the model inputs. Costs are presented in US dollars based on 2015 prices. The model outputs are total costs, drug costs, other medical costs, number of COPD exacerbations, and quality-adjusted life-years (QALYs). Costs and outcomes were discounted at a 3% annual rate. Incremental cost-effectiveness ratios were calculated. One-way and probabilistic sensitivity analyses were conducted to assess the effects of changing parameters on the uncertainty of the results.
  
  
  RESULTS
  UMEC/VI treatment for moderate to very severe COPD was associated with lower lifetime medical costs ($82,344) compared with TIO ($88,822), open dual LAMA + LABA treatment ($114,442), and no long-acting bronchodilator ($86,751). Fewer exacerbations were predicted to occur with UMEC/VI treatment compared with no long-acting bronchodilator treatment. UMEC/VI provided an 0.11 and 0.25 increase in QALYs compared with TIO and no long-acting bronchodilator treatment, and as such, dominated these cost-effectiveness analyses. Sensitivity analyses confirmed that the results were robust.
  
  
  CONCLUSIONS
  The results from this model suggest that UMEC/VI treatment would be dominant compared with TIO and no long-acting bronchodilator treatment, and less costly than open dual LAMA + LABA treatment in patients with moderate to very severe COPD.
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Wilson
authors.affiliation: GSK, Research Triangle Park, NC, USA; Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Jeetvan G
authors.initials: JG
authors.lastname: Patel
authors.affiliation: GSK, Research Triangle Park, NC, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Coleman
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: McDade
authors.affiliation: GSK, Research Triangle Park, NC, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Stanford
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Earnshaw
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D001592:Benzyl Alcohols / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D002722:Chlorobenzenes / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D019057:Quality-Adjusted Life Years; D011812:Quinuclidines / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D012720:Severity of Illness Index; D013997:Time Factors; D000069447:Tiotropium Bromide / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001592:Benzyl Alcohols; D001993:Bronchodilator Agents; D002722:Chlorobenzenes; D004338:Drug Combinations; C573971:GSK573719; D018727:Muscarinic Antagonists; D011812:Quinuclidines; C550468:vilanterol; D000069447:Tiotropium Bromide
keywords: COPD; cost-effectiveness; tiotropium; umeclidinium; vilanterol