Clinical study
Cost-effectiveness of inhaled corticosteroids for chronic obstructive pulmonary disease according to disease severity

https://doi.org/10.1016/j.amjmed.2003.09.027Get rights and content

Abstract

Purpose

Inhaled corticosteroids reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD), but their cost-effectiveness is not known.

Methods

We used a Markov model to determine, from a societal perspective, the cost-effectiveness of four treatment strategies involving inhaled corticosteroids: no use regardless of COPD severity; use in all disease stages; use in patients with stage 2 or 3 disease (forced expiratory volume in 1 second [FEV1] <50% of predicted); and use in patients with stage 3 disease (FEV1 <35% of predicted). Data from the literature were used to estimate mortality, exacerbation, and disease progression rates, as well as the costs associated with care and quality-adjusted life-years (QALYs), according to disease stage and use or nonuse of inhaled corticosteroids. A time horizon of 3 years was used.

Results

Use of inhaled corticosteroids in patients with stage 2 or 3 disease was associated with a cost of $17,000 per QALY gained. In stage 3 patients, use resulted in a cost of $11,100 per QALY gained. Providing inhaled corticosteroids to all COPD patients was associated with a less favorable cost-effectiveness ratio. Results were robust to various assumptions in a Monte Carlo simulation.

Conclusion

In patients with COPD, use of inhaled corticosteroids in those with stage 2 or 3 disease for 3 years results in improved quality-adjusted life expectancy at a cost that is similar to that of other therapies commonly used in clinical practice.

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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  • Cited by (0)

    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.

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