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Cost-effectiveness of combination therapy umeclidinium/vilanterol versus tiotropium in symptomatic COPD Spanish patients

Authors Miravitlles M, Gáldiz JB, Huerta Hernandez A, Villacampa Lordan A, Carcedo Rodriguez D, Garcia-Rio F

Received 8 August 2015

Accepted for publication 7 November 2015

Published 18 January 2016 Volume 2016:11(1) Pages 123—132

DOI https://doi.org/10.2147/COPD.S94006

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Professor Hsiao-Chi Chuang

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Marc Miravitlles,1 Juan B Gáldiz,2 Alicia Huerta,3 Alba Villacampa,4 David Carcedo,4 Francisco Garcia-Rio5

1Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, 2Pneumology Department, Hospital Universitario de Cruces, CIBER de Enfermedades Respiratorias (CIBERES), Bilbao, 3GlaxoSmithKline, Madrid, 4Oblikue Consulting, Barcelona, 5Pneumology Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain


Purpose: Umeclidinium/vilanterol (UMEC/VI) is a novel fixed dose combination of a long-acting muscarinic receptor antagonist (LAMA) and a long-acting beta 2 receptor antagonist (LABA) agent. This analysis evaluated the incremental cost-effectiveness ratio (ICER) of UMEC/VI compared with tiotropium (TIO), from the Spanish National Health System (NHS) perspective.
Methods: A previously published linked equations cohort model based on the epidemiological longitudinal study ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) was used. Patients included were COPD patients with a post-bronchodilator forced expiratory volume in 1 second (FEV1) ≤70% and the presence of respiratory symptoms measured with the modified Medical Research Council dyspnea scale (modified Medical Research Council ≥2). Treatment effect, expressed as change in FEV1 from baseline, was estimated from a 24-week head-to-head phase III clinical trial comparing once-daily UMEC/VI with once-daily TIO and was assumed to last 52 weeks following treatment initiation (maximum duration of UMEC/VI clinical trials). Spanish utility values were derived from a published local observational study. Unitary health care costs (€2015) were obtained from local sources. A 3-year time horizon was selected, and 3% discount was applied to effects and costs. Results were expressed as cost/quality-adjusted life years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) was performed.
Results: UMEC/VI produced additional 0.03 QALY and €590 vs TIO, leading to an ICER of €21,475/QALY. According to PSA, the probability of UMEC/VI being cost-effective was 80.3% at a willingness-to-pay of €30,000/QALY.
Conclusion: UMEC/VI could be considered as a cost-effective treatment alternative compared with TIO in symptomatic COPD patients from the Spanish NHS perspective.

Keywords: COPD, cost-effectiveness analysis, cost-utility analysis, umeclidinium/vilanterol, tiotropium

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