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Lu ZK, Xiong X, Lee T, Wu J, Yuan J, Jiang B. Big Data and Real-World Data based Cost-Effectiveness Studies and Decision-making Models: A Systematic Review and Analysis. Front Pharmacol 2021; 12:700012. [PMID: 34737696 PMCID: PMC8562301 DOI: 10.3389/fphar.2021.700012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/27/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Big data and real-world data (RWD) have been increasingly used to measure the effectiveness and costs in cost-effectiveness analysis (CEA). However, the characteristics and methodologies of CEA based on big data and RWD remain unknown. The objectives of this study were to review the characteristics and methodologies of the CEA studies based on big data and RWD and to compare the characteristics and methodologies between the CEA studies with or without decision-analytic models. Methods: The literature search was conducted in Medline (Pubmed), Embase, Web of Science, and Cochrane Library (as of June 2020). Full CEA studies with an incremental analysis that used big data and RWD for both effectiveness and costs written in English were included. There were no restrictions regarding publication date. Results: 70 studies on CEA using RWD (37 with decision-analytic models and 33 without) were included. The majority of the studies were published between 2011 and 2020, and the number of CEA based on RWD has been increasing over the years. Few CEA studies used big data. Pharmacological interventions were the most frequently studied intervention, and they were more frequently evaluated by the studies without decision-analytic models, while those with the model focused on treatment regimen. Compared to CEA studies using decision-analytic models, both effectiveness and costs of those using the model were more likely to be obtained from literature review. All the studies using decision-analytic models included sensitivity analyses, while four studies no using the model neither used sensitivity analysis nor controlled for confounders. Conclusion: The review shows that RWD has been increasingly applied in conducting the cost-effectiveness analysis. However, few CEA studies are based on big data. In future CEA studies using big data and RWD, it is encouraged to control confounders and to discount in long-term research when decision-analytic models are not used.
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Affiliation(s)
- Z Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
| | - Taiying Lee
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, United States
| | - Jing Yuan
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, China
| | - Bin Jiang
- Department of Administrative and Clinical Pharmacy, School of Pharmaceutical Sciences, Health Science Center, Peking University, Beijing, China
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Aguilar-Shea AL, Gallardo-Mayo C. [COPD inhaled therapy narrative review]. Semergen 2021; 48:214-218. [PMID: 34493458 DOI: 10.1016/j.semerg.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Inhaled therapy with long-acting bronchodilators is the base of pharmacological treatment in COPD. In order to find out those that offer better control, a search was carried out in Medline (Pubmed). Comparative studies of inhaler therapy in COPD patients were analyzed. The comparison between the fixed combination LABA/LAMA versus LABA/CI in non-exacerbating patients, revealed a better control with LABA/LAMA. Within the LABA/CI combinations, budesonide/formoterol combination offered better control. LAMA inhalers revealed no great differences, but when compared to LABA, it offered a better control. Regarding triple therapy in a single device, was superior to double therapy and to triple therapy in two devices, with no relevant differences among the available combinations.
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Affiliation(s)
- A L Aguilar-Shea
- Medicina Familiar y Comunitaria, Centro de Salud Puerta de Madrid, Atención Primaria de Madrid, Madrid, España.
| | - C Gallardo-Mayo
- Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Infanta Leonor, Madrid, España
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Impact of Real-World Data on Market Authorization, Reimbursement Decision & Price Negotiation. Ther Innov Regul Sci 2020; 55:228-238. [DOI: 10.1007/s43441-020-00208-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
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Aguilar-Shea AL, Bonis J. COPD from an everyday primary care point of view. J Family Med Prim Care 2019; 8:2644-2650. [PMID: 31548948 PMCID: PMC6753803 DOI: 10.4103/jfmpc.jfmpc_477_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/20/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction: The purpose of this study is to use real world evidence on treatment use to evaluate drug superiority within the same treatment group. Methods: Retrospective cohort analysis using the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP). Data includes longitudinal routine clinical data extracted from practice records of 7,890,485 patients. All subjects with an incident diagnosis of COPD in the database BIFAP between January 1 2010 and December 31 2012 were included in the cohort study. Cox regression analysis was performed to compare the hazard of COPD exacerbation outcome of the four principal cohorts (no therapy, monotherapy, double therapies with and without corticoids, and triple therapy) and within each principal cohort between the different treatment combinations. Results: 27,739 patients with COPD were included in the analysis. The median age was 64 years, male proportion was 69% and 70% were smokers. 58,042.9 person--years of follow-up were obtained for the cohort with a mean follow-up of 2.09 years per subject. The strongest factor associated with an increased risk of exacerbation was suffering an exacerbation the previous year (HR = 1.82[1.76--1.87 95%CI]). No differences were found between the most frequent monotherapies, double therapies without corticoid, or triple therapy. When comparing the different combinations of double therapies with corticoid, salmeterol/fluticasone combination (HR = 1.16[1.08--1.24]) revealed a higher adjusted hazard of exacerbation when compared with formoterol/budesonide. Conclusions: Treatment with a combination of budesonide/formoterol was associated with lower exacerbations than the treatment with fluticasone/salmeterol. The analysis did not reveal any differences in terms of exacerbation in monotherapy, double therapy without corticoids, and triple therapy combinations.
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Affiliation(s)
| | - Julio Bonis
- Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
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Hoogendoorn M, Corro Ramos I, Baldwin M, Gonzalez-Rojas Guix N, Rutten-van Mölken MPMH. Broadening the Perspective of Cost-Effectiveness Modeling in Chronic Obstructive Pulmonary Disease: A New Patient-Level Simulation Model Suitable to Evaluate Stratified Medicine. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:313-321. [PMID: 30832969 DOI: 10.1016/j.jval.2018.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/06/2018] [Accepted: 10/11/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To develop a health economic model that included a great diversity of patient characteristics and outcomes for chronic obstructive pulmonary disease (COPD), which can be used to inform decisions about stratified medicine in COPD. METHODS The choice of patient characteristics and outcomes to include in the model was based on 3 literature reviews on multidimensional prognostic COPD indices, COPD phenotypes, and treatment effects in subgroups. A conceptual model was constructed including 14 patient characteristics, 7 intermediate outcomes (lung function, physical activity, exercise capacity, symptoms, disease-specific quality of life, exacerbations, and pneumonias), and 3 final outcomes (mortality, quality-adjusted life-years [QALYs], and costs). Regression equations describing the statistical associations between the patient characteristics and intermediate and final outcomes were estimated using the longitudinal data of 5 large COPD trials (19,378 patients). A patient-level simulation model was developed in which individual patients from the baseline population of the 5 trials are sampled and their outcomes over lifetime are predicted based on the regression equations. RESULTS The base-case analysis (single-arm simulation representing treatment with tiotropium) showed that patients had a mean lung function decline of 43 mL/year, 0.62 exacerbations/year, a worsening of their physical activity and quality of life with 1.48 and 1.10 points/year, a life expectancy of 11.2 years, 7.25 QALYs, and total lifetime costs of £24,891. Results for a selection of treatment scenarios and subgroups were shown to demonstrate the potential of the model. CONCLUSIONS We developed a unique patient-level simulation model that can be used to evaluate COPD treatment options for a variety of subgroups.
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Affiliation(s)
- Martine Hoogendoorn
- Institute for Medical Technology Assessment/Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment/Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment/Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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6
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Aguilar-Shea A. EPOC, ¿cuál es el mejor tratamiento? Semergen 2018; 44:523-524. [DOI: 10.1016/j.semerg.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/05/2018] [Accepted: 03/26/2018] [Indexed: 10/16/2022]
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Affiliation(s)
- Evgenios I. Metaxas
- Department of Pulmonary Medicine, Evaggelismos General Hospital, Athens, Greece
- Department of Pulmonary Medicine, Polyclinic Ygia Hospital, Limassol, Cyprus
| | - Evangelos Balis
- Department of Pulmonary Medicine, Evaggelismos General Hospital, Athens, Greece
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Elliott RA, Tanajewski L, Gkountouras G, Avery AJ, Barber N, Mehta R, Boyd MJ, Latif A, Chuter A, Waring J. Cost Effectiveness of Support for People Starting a New Medication for a Long-Term Condition Through Community Pharmacies: An Economic Evaluation of the New Medicine Service (NMS) Compared with Normal Practice. PHARMACOECONOMICS 2017; 35:1237-1255. [PMID: 28776320 PMCID: PMC5684280 DOI: 10.1007/s40273-017-0554-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs. METHODS We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients' non-adherence. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted life-year (QALY) were calculated from the perspective of NHS England, using a lifetime horizon. RESULTS NMS generated a mean of 0.05 (95% CI 0.00-0.13) more QALYs per patient, at a mean reduced cost of -£144 (95% CI -769 to 73). The NMS dominates normal practice with a probability of 0.78 [incremental cost-effectiveness ratio (ICER) -£3166 per QALY]. NMS has a 96.7% probability of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY. CONCLUSIONS Our study suggests that the NMS increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost. TRIAL REGISTRATION ClinicalTrials.gov Trial reference number NCT01635361 ( http://clinicaltrials.gov/ct2/show/NCT01635361 ). Current Controlled trials: Trial reference number ISRCTN 23560818 ( http://www.controlled-trials.com/ISRCTN23560818/ ; DOI 10.1186/ISRCTN23560818 ). UK Clinical Research Network (UKCRN) study 12494 ( http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=12494 ). FUNDING Department of Health Policy Research Programme.
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Affiliation(s)
- Rachel A Elliott
- Manchester Centre for Health Economics, Room 4.318, 4th floor, Jean Mcfarlane Building, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Lukasz Tanajewski
- Division of Pharmacy Practice and Policy, The School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Georgios Gkountouras
- Division of Pharmacy Practice and Policy, The School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Anthony J Avery
- Primary Care Research, Division of Primary Care, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Nick Barber
- Emeritus Professor of Pharmacy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Rajnikant Mehta
- Research Design Service, East Midlands (RDS EM), School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Matthew J Boyd
- Division of Pharmacy Practice and Policy, The School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Asam Latif
- School of Health Sciences, Faculty of Medicine and Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Antony Chuter
- Patient and Public Representative, 68 Brighton Cottages, Copyhold Lane, Lindfield, Haywards Heath, RH16 1XT, UK
| | - Justin Waring
- Organisational Sociology and Improvement Science, Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Jubilee Campus, University of Nottingham, Nottingham, NG8 2BB, UK
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van der Schans S, Goossens LMA, Boland MRS, Kocks JWH, Postma MJ, van Boven JFM, Rutten-van Mölken MPMH. Systematic Review and Quality Appraisal of Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Recommendations. PHARMACOECONOMICS 2017; 35:43-63. [PMID: 27592021 PMCID: PMC5209411 DOI: 10.1007/s40273-016-0448-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Worldwide, chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung disease with considerable clinical and socioeconomic impact. Pharmacologic maintenance drugs (such as bronchodilators and inhaled corticosteroids) play an important role in the treatment of COPD. The cost effectiveness of these treatments has been frequently assessed, but studies to date have largely neglected the impact of treatment sequence and the exact stage of disease in which the drugs are used in real life. OBJECTIVE We aimed to systematically review recently published articles that reported the cost effectiveness of COPD maintenance treatments, with a focus on key findings, quality and methodological issues. METHODS We performed a systematic literature search in Embase, PubMed, the UK NHS Economic Evaluation Database (NHS-EED) and EURONHEED (European Network of Health Economics Evaluation Databases) and included all relevant articles published between 2011 and 2015 in either Dutch, English or German. Main study characteristics, methods and outcomes were extracted and critically assessed. The Quality of Health Economic Studies (QHES) instrument was used as basis for quality assessment, but additional items were also addressed. RESULTS The search identified 18 recent pharmacoeconomic analyses of COPD maintenance treatments. Papers reported the cost effectiveness of long-acting muscarinic antagonist (LAMA) monotherapy (n = 6), phosphodiesterase (PDE)-4 inhibitors (n = 4), long-acting beta agonist/inhaled corticosteroid (LABA/ICS) combinations (n = 4), LABA monotherapy (n = 2) and LABA/LAMA combinations (n = 2). All but two studies were funded by the manufacturer, and all studies indicated favourable cost effectiveness; however, the number of quality-adjusted life-years (QALYs) gained was small. Less than half of the studies reported a COPD-specific outcome in addition to a generic outcome (mostly QALYs). Exacerbation and mortality rates were found to be the main drivers of cost effectiveness. According to the QHES, the quality of the studies was generally sufficient, but additional assessment revealed that most studies poorly represented the cost effectiveness of real-life medication use. CONCLUSIONS The majority of studies showed that pharmacologic COPD maintenance treatment is cost effective, but most studies poorly reflected real-life drug use. Consistent and COPD-specific methodology is recommended.
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Affiliation(s)
- Simon van der Schans
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Lucas M A Goossens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Melinde R S Boland
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Janwillem W H Kocks
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
- Center for Pharmaceutical Outcomes Research, School of Pharmacy, University of Colorado, Denver, CO, USA.
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Zafari Z, Bryan S, Sin DD, Conte T, Khakban R, Sadatsafavi M. A Systematic Review of Health Economics Simulation Models of Chronic Obstructive Pulmonary Disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:152-162. [PMID: 28212957 DOI: 10.1016/j.jval.2016.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/01/2016] [Accepted: 08/09/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Many decision-analytic models with varying structures have been developed to inform resource allocation in chronic obstructive pulmonary disease (COPD). OBJECTIVES To review COPD models for their adherence to the best practice modeling recommendations and their assumptions regarding important aspects of the natural history of COPD. METHODS A systematic search of English articles reporting on the development or application of a decision-analytic model in COPD was performed in MEDLINE, Embase, and citations within reviewed articles. Studies were summarized and evaluated on the basis of their adherence to the Consolidated Health Economic Evaluation Reporting Standards. They were also evaluated for the underlying assumptions about disease progression, heterogeneity, comorbidity, and treatment effects. RESULTS Forty-nine models of COPD were included. Decision trees and Markov models were the most popular techniques (43 studies). Quality of reporting and adherence to the guidelines were generally high, especially in more recent publications. Disease progression was modeled through clinical staging in most studies. Although most studies (n = 43) had incorporated some aspects of COPD heterogeneity, only 8 reported the results across subgroups. Only 2 evaluations explicitly considered the impact of comorbidities. Treatment effect had been mostly modeled (20) as both reduction in exacerbation rate and improvement in lung function. CONCLUSIONS Many COPD models have been developed, generally with similar structural elements. COPD is highly heterogeneous, and comorbid conditions play an important role in its burden. These important aspects, however, have not been adequately addressed in most of the published models.
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Affiliation(s)
- Zafar Zafari
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- Center for Heart and Lung Innovation (James Hogg Research Center), St. Paul's Hospital, Vancouver, British Columbia, Canada; Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; The PROOF Centre of Excellence, Vancouver, British Columbia, Canada
| | - Tania Conte
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rahman Khakban
- The PROOF Centre of Excellence, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, University of British Columbia, Vancouver, British Columbia, Canada; Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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van Boven JF, Kocks JW, Postma MJ. Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium-olodaterol for patients with COPD in the Netherlands. Int J Chron Obstruct Pulmon Dis 2016; 11:2191-2201. [PMID: 27703341 PMCID: PMC5036592 DOI: 10.2147/copd.s114738] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol showed increased effectiveness regarding lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with the use of its mono-components. Yet, while effectiveness and safety have been shown, the health economic implication of this treatment is still unknown. The aim of this study was to assess the cost–utility and budget impact of tiotropium–olodaterol FDC in patients with moderate to very severe COPD in the Netherlands. Patients and methods A cost–utility study was performed, using an individual-level Markov model. To populate the model, individual patient-level data (age, height, sex, COPD duration, baseline forced expiratory volume in 1 second) were obtained from the tiotropium–olodaterol TOnado trial. In the model, forced expiratory volume in 1 second and patient-level data were extrapolated to utility and survival, and treatment with tiotropium–olodaterol FDC was compared with tiotropium. Cost–utility analysis was performed from the Dutch health care payer’s perspective using a 15-year time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%). Both univariate and probabilistic sensitivity analyses were performed. Budget impact was annually assessed over a 5-year time horizon, taking into account different levels of medication adherence. Results As a result of cost increases, combined with quality-adjusted life-year (QALY) gains, results showed that tiotropium–olodaterol FDC had an incremental cost-effectiveness ratio of €7,004/QALY. Without discounting, the incremental cost-effectiveness ratio was €5,981/QALY. Results were robust in univariate and probabilistic sensitivity analyses. Budget impact was estimated at €4.3 million over 5 years assuming 100% medication adherence. Scenarios with 40%, 60%, and 80% adherence resulted in lower 5-year incremental cost increases of €1.7, €2.6, and €3.4 million, respectively. Conclusion Tiotropium–olodaterol FDC can be considered a cost-effective treatment under current Dutch cost-effectiveness thresholds.
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Affiliation(s)
- Job Fm van Boven
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics; Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC)
| | - Janwillem Wh Kocks
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC)
| | - Maarten J Postma
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics; Institute of Science in Healthy Aging & healthcaRE (SHARE); Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
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McLean S, Hoogendoorn M, Hoogenveen RT, Feenstra TL, Wild S, Simpson CR, Mölken MRV, Sheikh A. Projecting the COPD population and costs in England and Scotland: 2011 to 2030. Sci Rep 2016; 6:31893. [PMID: 27583987 PMCID: PMC5008118 DOI: 10.1038/srep31893] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/22/2016] [Indexed: 12/21/2022] Open
Abstract
We aimed to estimate the prevalence, healthcare costs and number of deaths among people with chronic obstructive pulmonary disease (COPD) in England and Scotland 2011–2030. We adapted the Dutch COPD Model by using English and Scottish demographic, COPD incidence, COPD prevalence, smoking prevalence and mortality data to make projections. In England, the prevalence of COPD was estimated to be 1.79% (95% uncertainty interval 1.77–1.81) in 2011, increasing to 2.19% (1.85–2.33) by 2030. In Scotland, prevalence was 2.03% (1.96–2.10) in 2011 increasing to 2.20% (1.98–2.40) in 2030. These increases were driven by more women developing COPD. Annual direct healthcare costs of COPD in England were estimated to increase from £1.50 billon (1.18–2.50) in 2011 to £2.32 (1.85–3.08) billion in 2030. In Scotland, costs increased from £159 million (128–268) in 2011 to £207 (165–274) million in 2030. The deaths in England were estimated to increase from 99,200 (92,500–128,500) in 2011, to 129,400 (126,400–133,400) by 2030. In Scotland, in 2011 there were 9,700 (9,000–12,300) deaths and 13,900 (13,400–14,500) deaths in 2030. The number of people with COPD will increase substantially over the coming years in England and Scotland, particularly in females. Services need to adapt to this increasing demand.
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Affiliation(s)
- Susannah McLean
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Martine Hoogendoorn
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Rudolf T Hoogenveen
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Talitha L Feenstra
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Sarah Wild
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Colin R Simpson
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | | | - Aziz Sheikh
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
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Selya-Hammer C, Gonzalez-Rojas Guix N, Baldwin M, Ternouth A, Miravitlles M, Rutten-van Mölken M, Goosens LMA, Buyukkaramikli N, Acciai V. Development of an enhanced health-economic model and cost-effectiveness analysis of tiotropium + olodaterol Respimat® fixed-dose combination for chronic obstructive pulmonary disease patients in Italy. Ther Adv Respir Dis 2016; 10:391-401. [PMID: 27405723 PMCID: PMC5933617 DOI: 10.1177/1753465816657272] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The objective of this study was to compare the cost-effectiveness of the fixed-dose combination (FDC) of tiotropium + olodaterol Respimat(®) FDC with tiotropium alone for patients with chronic obstructive pulmonary disease (COPD) in the Italian health care setting using a newly developed patient-level Markov model that reflects the current understanding of the disease. METHODS While previously published models have largely been based around a cohort approach using a Markov structure and GOLD stage stratification, an individual-level Markov approach was selected for the new model. Using patient-level data from the twin TOnado trials assessing Tiotropium + olodaterol Respimat(®) FDC versus tiotropium, outcomes were modelled based on the trough forced expiratory volume (tFEV1) of over 1000 patients in each treatment arm, tracked individually at trial visits through the 52-week trial period, and after the trial period it was assumed to decline at a constant rate based on disease stage. Exacerbation risk was estimated based on a random-effects logistic regression analysis of exacerbations in UPLIFT. Mortality by age and disease stage was estimated from an analysis of TIOSPIR trial data. Cost of bronchodilators and other medications, routine management, and costs of treatment for moderate and severe exacerbations for the Italian setting were included. A cost-effectiveness analysis was conducted over a 15-year time horizon from the perspective of the Italian National Health Service. RESULTS Aggregating total costs and quality-adjusted life years (QALYs) for each treatment cohort over 15 years and comparing tiotropium + olodaterol Respimat(®) FDC with tiotropium alone, resulted in mean incremental costs per patient of €1167 and an incremental cost-effectiveness ratio (ICER) of €7518 per additional QALY with tiotropium + olodaterol Respimat(®) FDC. The lung function outcomes observed for tiotropium + olodaterol Respimat(®) FDC in TOnado drove the results in terms of slightly higher mean life-years (12.24 versus 12.07) exacerbation-free months (11.36 versus 11.32) per patient and slightly fewer moderate and severe exacerbations per patient-year (0.411 versus 0.415; 0.21 versus 0.24) versus tiotropium. Probabilistic sensitivity analyses showed tiotropium + olodaterol Respimat(®) FDC to be the more cost-effective treatment in 95.2% and 98.4% of 500 simulations at thresholds of €20,000 and €30,000 per QALY respectively. CONCLUSION Tiotropium + olodaterol Respimat(®) FDC is a cost-effective bronchodilator in the maintenance treatment of COPD for the Italian health care system.
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Affiliation(s)
| | | | | | - Andrew Ternouth
- Boehringer Ingelheim Ltd., Ellesfield Avenue, Bracknell, Berkshire, UK
| | - Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron, Ciber of Respiratory Diseases (CIBERES), Barcelona, Spain
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Eklund O, Afzal F, Borgström F, Flavin J, Ternouth A, Ojanguren ME, Crespo C, Baldwin M. Cost-effectiveness of tiotropium versus glycopyrronium in moderate to very severe chronic obstructive pulmonary disease in Canada, Spain, Sweden, and the UK. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:243-52. [PMID: 27354818 PMCID: PMC4910617 DOI: 10.2147/ceor.s105579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Tiotropium (TIO), Spiriva® Handihaler®, is a well-established bronchodilator, LAMA (long acting muscarinic antagonist), for the treatment of moderate to very severe chronic obstructive pulmonary disease (COPD). Clinical evidence from the SPARK trial suggests that TIO is superior to glycopyrronium (GLY), Seebri® Breezhaler®, in terms of severe exacerbations. This modeling study assessed the cost-effectiveness of TIO versus GLY for Canada (CAN), Spain (ESP), Sweden (SWE), and the UK, making use of this new clinical evidence. METHODS A Markov cohort model, with moderate to very severe (Global Initiative for Chronic Obstructive Lung Disease II-IV) COPD patients, was populated with efficacy data from the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) and SPARK trials as well as costs, utilities, and epidemiological data relevant for each country. Treatment efficacy was modeled as improvements in lung function, quality-adjusted life years (QALYs), and as a lowering of the risk of exacerbations (rate of exacerbations). Risks of exacerbations differed between cohorts based on data from SPARK. Health and cost outcomes were simulated over an approximate lifetime horizon, starting from the age of 65 years. Robustness of results was validated in deterministic sensitivity analyses. RESULTS Over the lifetime horizon, patients treated with TIO accumulated -623 (CAN), 1,066 (ESP), 1,137 (SWE), and -169 (UK), respectively, in incremental costs (€2014). TIO generated better health outcomes compared to GLY in all countries, 0.21 (CAN), 0.25 (ESP), 0.23 (SWE), and 0.23 (UK) in incremental QALYs. The cost per QALY gained was found to be €4,281 and €1,137 for ESP and SWE, respectively, while TIO was found to be cost saving in CAN and the UK. The results were mainly driven by the relative risk of severe exacerbations found in SPARK (GLY/TIO relative risk: 1.43, 95% confidence interval: 1.05-1.97, P=0.025). CONCLUSION The results from this study show that TIO is a cost-effective treatment compared to GLY in moderate to very severe COPD. The cost per QALY is well below the existing implicit and explicit willingness-to-pay thresholds.
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Affiliation(s)
| | | | | | | | | | | | - Carlos Crespo
- Boehringer Ingelheim, Sant Cugat del Vallès, Barcelona, Spain
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16
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Einarson TR, Bereza BG, Nielsen TA, Van Laer J, Hemels MEH. Systematic review of models used in economic analyses in moderate-to-severe asthma and COPD. J Med Econ 2016; 19:319-55. [PMID: 26535917 DOI: 10.3111/13696998.2015.1116991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Respiratory diseases exert a substantial burden on society, with newer drugs increasingly adding to the burden. Economic models are often used, but seldom reviewed. PURPOSE To summarize economic models used in economic analyses of drugs treating moderate-to-severe/very severe asthma or chronic obstructive pulmonary disease (COPD). METHODS This study searched Medline and Embase from inception to the end of February 2015 for cost-effectiveness/utility analyses that examined at least one drug against placebo, another drug, or other standard therapy in asthma or COPD. Two reviewers independently searched and extracted data with differences adjudicated via consensus discussion. Data extracted included model used and its qualities, validation methods, treatments compared, disease severity, analytic perspective, time horizon, data collection (pro- or retrospective), input rates and sources, costs and sources, planned sensitivity analyses, criteria for cost-effectiveness, reported outcomes, and sponsor. RESULTS This study analyzed 53 articles; 14 (25%) on asthma and 39 (75%) COPD. Markov models were commonly used for both asthma and COPD-related economic evaluations. Relatively few studies validated their model. For asthma-related studies, 10 examined inhaled corticosteroids and nine studied omalizumab. Placebo or standard therapy was the comparison in 11 studies and active drugs in the remainder. CONCLUSIONS Few studies include validation of their models. Furthermore, controversy concerning some results was uncovered in this study, which needs to be avoided in the future.
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Affiliation(s)
- Thomas R Einarson
- a a Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Canada
| | - Basil G Bereza
- a a Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Canada
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Costa-Scharplatz M, Ställberg B, Goyal P, Asukai Y, Gruenberger JB, Price D. Cost-Effectiveness of Glycopyrronium Bromide Compared with Tiotropium in Patients with Chronic Obstructive Pulmonary Disease in Sweden. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:637-645. [PMID: 26324401 DOI: 10.1007/s40258-015-0193-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES 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. CONCLUSION 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.
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Affiliation(s)
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | | | | | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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18
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Eklund O, Afzal F, Borgström F. Cost-effectiveness of tiotropium versus usual care and glycopyrronium in the treatment of chronic obstructive pulmonary disease in Sweden. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:13. [PMID: 26288574 PMCID: PMC4539698 DOI: 10.1186/s12962-015-0040-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Tiotropium (TIO) is a well-established bronchodilator, LAMA (long-acting anticholinergic), for the treatment of moderate to very severe chronic obstructive pulmonary disease (COPD). Clinical evidence suggests that tiotropium is superior to usual non-LAMA care (UC) but may also have benefits compared to other LAMAs in preventing and limiting the effects of severe exacerbations. The primary objective of this study was to undertake a cost-effectiveness analysis of adding tiotropium to usual care versus usual care alone. A secondary objective was to assess the cost-effectiveness of tiotropium compared to glycopyrronium (GLY), another LAMA. The study was conducted with a Swedish setting in mind. Methods A Markov cohort model, incorporating the effects of exacerbations, was populated with efficacy data from the UPLIFT and SPARK trials and epidemiological data relevant for a Swedish patient population. Treatment efficacy of tiotropium was modelled as a lowering of the risk of exacerbations and as a slow-down of overall disease progression. The model followed patients over their remaining life-time. Results The base case analysis showed that patients treated with tiotropium gained 0.07 quality-adjusted life years (QALYs) compared to usual care alone at an incremental cost of SEK 15,041, resulting in a cost per QALY gained of SEK 224,850. Compared to glycopyrronium the QALY gained was estimated to 0.23 QALYs in favour of tiotropium at an incremental cost of SEK 2423, yielding a cost per QALY gained of SEK 10,456. The results were mainly driven by differences in the risk of severe exacerbations. Conclusion At the current implicit willingness-to-pay (WTP) per QALY threshold in Sweden, the results from this study indicate that tiotropium is a highly cost-effective intervention when added to usual non-LAMA care in the treatment of moderate to very severe COPD in Sweden. In addition, tiotropium is a highly cost-effective intervention when compared to glycopyrronium monotherapy.
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Affiliation(s)
| | - Faraz Afzal
- Boehringer Ingelheim Norway KS, Asker, Norway
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Einarson TR, Bereza BG, Nielsen TA, Hemels MEH. Utilities for asthma and COPD according to category of severity: a comprehensive literature review. J Med Econ 2015; 18:550-63. [PMID: 25735652 DOI: 10.3111/13696998.2015.1025793] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are incurable diseases that impact quality-of-life. OBJECTIVE To summarize original research articles that measured or utilized preference-based utilities or disutilities according to disease severity. METHODS Medline and Embase were searched from inception until the end of November 2014. Two reviewers independently searched the literature with differences settled through discussion. Data extracted included utility scores as determined in original research categorized according to disease severity as well as disutilities associated with exacerbations or comorbidities. Data were tabulated and analyzed descriptively. RESULTS In total, 862 articles were identified, 790 were rejected, and 69 analyzed. There were 44 dealing with COPD and 25 with asthma. Average utilities determined by research were 0.828 ± 0.062, 0.765 ± 0.090, 0.711 ± 0.120, and 0.607 ± 0.120 for mild, moderate, severe, and very severe COPD, respectively. Utilities used in economic analyses were 0.866 ± 0.038, 0.770 ± 0.024, 0.739 ± 0.045, and 0.596 ± 0.075, respectively. Disutilities (annual) ranged from 0.002-0.378; major and minor exacerbations had respective disutilities of 0.287 and 0.108. For asthma patients, utilities were for 0.86 ± 0.32, 0.83 ± 0.065, and 0.74 ± 0.029, for mild, moderate, and severe disease, respectively. CONCLUSIONS Utilities have been summarized according to severity category of asthma and COPD. These values should be useful for researchers undertaking economic analyses of these diseases.
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Affiliation(s)
- Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
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20
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Rizzi CF, Ferraz MB, Poyares D, Tufik S. Quality-adjusted life-years gain and health status in patients with OSAS after one year of continuous positive airway pressure use. Sleep 2014; 37:1963-8. [PMID: 25325505 DOI: 10.5665/sleep.4250] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/26/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To estimate the health utility score and quality-adjusted life-years (QALY) index of obstructive sleep apnea syndrome (OSAS) in patients over 1 y of continuous positive airway pressure (CPAP) treatment. DESIGN Longitudinal interventional study. SETTING The study was carried out in Sao Paulo Sleep Institute, Brazil. PATIENTS AND PARTICIPANTS Ninety-five patients with OSAS and with apnea-hypopnea index (AHI) > 20 of either sex, body mass index < 40 kg/m(2), and no previous contact with CPAP were included. INTERVENTIONS The participants underwent baseline and titration polysomnographies, clinical evaluation, and ambulatory blood pressure (BP) measurement, completed Short-Form 6 Dimension Health Survey (SF-6D) and Epworth Sleepiness Scale (ESS) questionnaires, and implementation of CPAP. The patients were followed for 1 y. MEASUREMENTS AND RESULTS The mean AHI and age were 57.6 ± 29.2 events/h and 53.3 ± 9.3 y, respectively. One year of CPAP treatment increased the health utility score from 0.611 ± 0.112 to 0.710 ± 0.121 (P < 0.01). Therefore, CPAP resulted in a mean gain of 0.092 QALY/patient. The improvements in utility scores were associated with decreases in the ESS after 1 mo, in systolic BP after 1 y, and in diastolic BP at 6 mo. BP normalization group (≤ 130/85 mmHg) showed higher QALY than that of the non-normalization group (0.10 ± 0.09 versus 0.05 ± 0.10; P = 0.03). One-year ESS score (P = 0.03), diastolic BP reduction P = 0.01) and baseline utility scores (P < 0.01) were significantly associated with QALY gain. CONCLUSION This study showed a significant QALY/patient gain after 1 y of regular CPAP use. In addition, BP normalization was associated with higher QALY gain. Thus, utility studies can provide more complete analyses of the total benefits of CPAP treatment in patients with OSAS and should be encouraged.
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Affiliation(s)
- Camila F Rizzi
- Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Marcos B Ferraz
- Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil: Sao Paulo Center for Health Economics - GRIDES, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Dalva Poyares
- Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Sleep Medicine and Biology Discipline, Psychobiology Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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21
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Pietzsch JB, Garner A, Herth FJF. Cost-effectiveness of endobronchial valve therapy for severe emphysema: a model-based projection based on the VENT study. Respiration 2014; 88:389-98. [PMID: 25277549 DOI: 10.1159/000368088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/28/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endobronchial valve (EBV) therapy is an innovative treatment that has been shown to be safe and effective in selected subgroups of patients with severe emphysema. OBJECTIVES The objective of our study was to assess the cost-effectiveness of EBV therapy compared to the medical management of patients with high heterogeneity, complete fissures and lobar exclusion in the context of the German health-care system. METHODS Clinical data from a subset of VENT (Endobronchial Valve for Emphysema Palliation Trial) provided information about clinical events, health-related quality of life, and disease staging for 12 months. This information was subsequently used to project long-term disease progression, mortality, and health resource utilization. We computed the 5- and 10-year incremental cost-effectiveness ratio (ICER) in euros per quality-adjusted life year (QALY). Costs and effects were discounted at 3% per year. RESULTS EBV therapy led to clinically meaningful disease restaging at 12 months (37.8% of the cohort improved staging, compared to 0% in the controls). Over 5 years, EBV therapy was projected to increase survival from 66.4 to 70.7%, and to add 0.22 QALYs. Costs were estimated to increase by EUR 10,299, resulting in an ICER of EUR 46,322 per QALY. Over 10 years, 0.41 QALYs were gained at an additional cost of EUR 10,425, yielding an ICER of EUR 25,142 per QALY. CONCLUSIONS Our model-based analysis suggests that EBV therapy leads to clinically meaningful changes in disease staging and progression when compared to medical management, with resulting gains in unadjusted and quality-adjusted life expectancy. Our results indicate that EBV therapy is cost-effective in the German health-care system.
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Saturni S, Bellini F, Braido F, Paggiaro P, Sanduzzi A, Scichilone N, Santus PA, Morandi L, Papi A. Randomized Controlled Trials and real life studies. Approaches and methodologies: a clinical point of view. Pulm Pharmacol Ther 2014; 27:129-38. [PMID: 24468677 DOI: 10.1016/j.pupt.2014.01.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 01/11/2014] [Accepted: 01/13/2014] [Indexed: 12/31/2022]
Abstract
Randomized Controlled Trials (RCTs) are the "gold standard" for evaluating treatment outcomes providing information on treatments "efficacy". They are designed to test a therapeutic hypothesis under optimal setting in the absence of confounding factors. For this reason they have high internal validity. The strict and controlled conditions in which they are conducted, leads to low generalizability because they are performed in conditions very different from real life usual care. Conversely, real life studies inform on the "effectiveness" of a treatment, that is, the measure of the extent to which an intervention does what is intended to do in routine circumstances. At variance to RCTs, real life trials have high generalizability, but low internal validity. Recently the number of real life studies has been rapidly growing in different areas of respiratory medicine, particularly in asthma and COPD. The role of such studies is becoming a hot topic in respiratory medicine, attracting research interest and debate. In the first part of this review we discuss some of the advantages and disadvantages of different types of RCTs and analyze the strengths and weaknesses of real life trials, considering the recent examples of some studies conducted in COPD. We then discuss methodological approaches and options to overcome some of the limitations of real life studies. Comparing the conclusions of effectiveness and efficacy trials can provide important pieces of information. Indeed, these approaches can result complementary, and they can guide the interpretation of each other results.
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Affiliation(s)
- S Saturni
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Bellini
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Braido
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCS AOU San Martino-IST, Genoa, Italy
| | - P Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - A Sanduzzi
- Section of Respiratory Diseases, Department of Surgery and Clinical Medicine, University of Naples, Italy
| | - N Scichilone
- Department of Internal Medicine, Section of Pulmonology (DIBIMIS), University of Palermo, Italy
| | - P A Santus
- Dipartimento di Scienze della Salute, Pneumologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Milano IRCCS, University of Milan, Milan, Italy
| | - L Morandi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
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Steiropoulos P, Archontogeorgis K, Nena E, Bouros D. New developments in the management of COPD: clinical utility of indacaterol 75 μg. Int J Chron Obstruct Pulmon Dis 2013; 9:1-7. [PMID: 24353414 PMCID: PMC3862584 DOI: 10.2147/copd.s24940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health challenge and a major cause of mortality worldwide. Bronchodilators, particularly long-acting β2-agonists and long-acting antimuscarinic agents, used singly or in combination, aim to improve lung function, reduce symptoms, prevent exacerbations, and enhance quality of life of COPD patients. Indacaterol is a novel, inhaled, long-acting β2-agonist, with rapid onset of action and once-daily dosing providing 24-hour bronchodilation. Currently, the recommended dose differs between Europe (150 μg; maximum 300 μg) and USA (75 μg), the latter is lower than that assessed in the majority of the conducted studies. This review summarises published evidence regarding the efficacy, tolerability, and safety of indacaterol at a dose of 75 μg. Indacaterol 75 μg was found to be superior than placebo regarding lung function, dyspnea, health status, use of rescue medication, and rate of exacerbations. Furthermore, indacaterol 75 μg was well tolerated, while the most frequent adverse effect was deterioration of COPD occurring at a frequency similar to placebo, without major cardiovascular adverse effects. In conclusion, indacaterol 75 μg, administered once daily, is efficacious and has an excellent tolerability and safety profile, and is therefore a valid alternative in the treatment of COPD patients.
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Affiliation(s)
- Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kostas Archontogeorgis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Demosthenes Bouros
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Cazzola M, Bardaro F, Stirpe E. The role of indacaterol for chronic obstructive pulmonary disease (COPD). J Thorac Dis 2013; 5:559-66. [PMID: 23991316 DOI: 10.3978/j.issn.2072-1439.2013.07.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/26/2013] [Indexed: 11/14/2022]
Abstract
Indacaterol is the first long-acting β2-agonist (LABAs) approved for the treatment of chronic obstructive pulmonary disease (COPD) that allows for once-daily (OD) administration. It is rapidly acting, with an onset of action in 5 minutes, like salbutamol and formoterol but with a sustained bronchodilator effect, that last for 24 hours, like tiotropium. In long-term clinical studies (12 weeks to 1 year) in patients with moderate to severe COPD, OD indacaterol 150 or 300 μg improved lung function (primary endpoint) significantly more than placebo, and improvements were significantly greater than twice-daily formoterol 12 μg or salmeterol 50 μg, and noninferior to OD tiotropium bromide 18 μg. Indacaterol was well tolerated at all doses and with a good overall safety profile. Cost-utility analyses show that indacaterol 150 μg has lower total costs and better outcomes than tiotropium and salmeterol. These findings suggest that indacaterol can be considered a first choice drug in the treatment of the patient with mild/moderate stable COPD. However, in people with COPD who remain symptomatic on treatment with indacaterol, adding a long-acting muscarinic antagonist (LAMA) is the preferable option. In any case, it is advisable to combine indacaterol with a OD inhaled corticosteroid (ICS), such as mometasone furoate or ciclesonide, in patients with low FEV1, and, in those patients who have many symptoms and a high risk of exacerbations, to combine it with a LAMA and a OD ICS.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Clinical Pharmacology, Department of System Medicine, University of Rome "Tor Vergata", Rome, Italy
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