Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and brochodilators for severe and very severe COPD patients

Roberto Dal Negro¹, M Eandi², L Pradelli³, S Iannazzo³

¹Lung Dept., Orlandi General Hospital, Bussolengo, Verona, Italy; ²Clinical Pharmacology, University of Torino, Italy; ³Advanced Research, Torino, Italy

Abstract: Current practice guidelines for the treatment of COPD recommend the use of combined inhaled corticosteroids and long-acting bronchodilators in severe and very severe patients (GOLD stages III and IV). The aim of this study was to evaluate, through a simulation model, the economic consequences of this recommendation in Italy. We developed a cost-effectiveness analysis (CEA) on five alternative therapeutic strategies (salmeterol/fluticasone, SF; formoterol/budesonide, FB; salmeterol alone, S; fluticasone alone, F; control, C). Published data on the Italian COPD population and efficacy data from international reference trials were fitted in a disease progression model based on a Markov chain representing severity stages and death. The yearly total direct costs of treating COPD patients in Italy was estimated at approximately €7 billion, with a mean cost per patient per year of around €2450. Mean survival of the cohort is 11.5 years. The C and F strategies were dominated (ie, are associated with worse outcomes and higher costs) by all alternatives. SF and FB were the most effective strategies, with a slight clinical superiority of SF, but they were also marginally more expensive than S. Incremental cost-effectiveness of SF vs S was €679.5 per avoided exacerbation and €3.3 per symptom-free day. Compared with current practice, the recommended use of combined inhaled corticosteroids and long-acting bronchodilators for severe and very severe COPD patients has the potential for improving clinical outcomes without increasing healthcare costs.

Keywords: severe COPD, pharmacoeconomics, Markov chain, inhaled corticosteroids, inhaled bronchodilators, cost-effectiveness