Clinical studyCost-effectiveness of inhaled corticosteroids for chronic obstructive pulmonary disease according to disease severity☆
Section snippets
Design of the model
We designed a simulation model to estimate, from a societal perspective, the clinical effects and costs of using (or not using) inhaled corticosteroids in patients with varying severity of COPD. The baseline model used an analytic horizon of 3 years divided in 3-month increments. The model was limited to 3 years because there were insufficient data on the efficacy of inhaled corticosteroids beyond this time horizon. We used a 3-month window for calculating transitional probabilities to allow
Results
The characteristics of the representative sample of patients with COPD used in the models were as follows: mean age, 61 years; 21% female; 87% white; 97% former or current smokers; 40% current smokers; and 54 pack-years of smoking (25).
Discussion
We developed an economic model to determine the cost-effectiveness of using inhaled corticosteroids in patients with varying severity of COPD, and found that treatment was most cost-effective when given to patients with stage 2 or 3 disease (FEV1 <50% of predicted). Compared with the base case strategy (no treatment for any COPD patients), therapy restricted to patients with stage 3 disease (FEV1 <35% of predicted) was associated with a cost of $11,100 per QALY gained; therapy restricted to
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This project was funded in part by an unrestricted research grant from GlaxoSmithKline Canada Inc., Mississauga, Ontario, Canada, and the Institute of Health Economics, Edmonton, Alberta.
Dr. Sin is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research. Drs. Sin and Jacobs have received honoraria and research funding from AstraZeneca and GlaxoSmithKline.