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1 Institute for Medical Technology Assessment, Erasmus University, Rotterdam, 2 Dept of Respiratory Diseases, Atrium Medisch Centrum, Heerlen, The Netherlands. 3 Respiratory Division, Academic Hospital Vrije, Universiteit Brussel, Belgium
CORRESPONDENCE: J.B. Oostenbrink, Erasmus Medical Centre, Institute for Medical Technology Assessment, PO box 1738, 3000 DR, Rotterdam, The Netherlands. Fax: +31 104089092. E-mail: oostenbrink@bmg.eur.nl
Keywords: bronchodilator, chronic obstructive pulmonary disease, cost-effectiveness, economic evaluation
Received: July 18, 2003
Accepted October 15, 2003
The study has been financially supported by a grant from Boehringer Ingelheim GmbH.
The aim of this paper is to assess the health economic consequences of substituting ipratropium with the new, once-daily bronchodilator tiotropium in patients with a diagnosis of chronic obstructive pulmonary disease (COPD).
This prospective cost-effectiveness analysis was performed alongside two 1-yr randomised, double-blind clinical trials in the Netherlands and Belgium. Patients had a diagnosis of COPD and a forced expiratory volume in one second (FEV1)
The mean number of exacerbations was reduced from 1.01 in the ipratropium group (n=175) to 0.74 in the tiotropium group (n=344). The percentages of patients with a relevant improvement on the St. George's Respiratory Questionnaire (SGRQ) were 34.6% and 51.2% respectively. Compared to ipratropium, the number of hospital admissions, hospital days and unscheduled visits to healthcare providers was reduced by 46%, 42% and 36% respectively. Mean annual healthcare costs including the acquisition cost of the study drugs were 1721 (sem 160) in the tiotropium group and 1,541 (SEM 163) in the ipratropium group (difference 180). Incremental cost-effectiveness ratios were 667 per exacerbation avoided and 1084 per patient with a relevant improvement on the SGRQ.
Substituting tiotropium for ipratropium in chronic obstructive pulmonary disease patients offers improved health outcomes and is associated with increased costs of 180 per patient per year.
65% predicted normal. Patients were randomised to tiotropium (18 µg once daily) or ipratropium (2 puffs of 20 µg administered four times daily) in a ratio of 2:1.
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