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Cost-effectiveness of tiotropium versus glycopyrronium in moderate to very severe chronic obstructive pulmonary disease in Canada, Spain, Sweden, and the UK

Authors Eklund O, Afzal F, Borgström F, Flavin J, Ternouth A, Ojanguren ME, Crespo C, Baldwin M

Received 2 February 2016

Accepted for publication 11 April 2016

Published 11 June 2016 Volume 2016:8 Pages 243—252


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Oskar Eklund,1 Faraz Afzal,2 Fredrik Borgström,1 Jason Flavin,3 Andrew Ternouth,4 Maria Eugenia Ojanguren,5 Carlos Crespo,5 Mike Baldwin6

1Quantify Research AB, Stockholm, Sweden; 2Boehringer Ingelheim, Asker, Norway; 3Boehringer Ingelheim, Burlington, ON, Canada; 4Boehringer Ingelheim, Bracknell, Berkshire, UK; 5Boehringer Ingelheim, Sant Cugat del Vallès, Barcelona, Spain; 6Boehringer Ingelheim, Ingelheim, Germany

Objectives: Tiotropium (TIO), Spiriva® Handihaler®, is a well-established bronchodilator, LAMA (long acting muscarinic antagonist), for the treatment of moderate to very severe chronic obstructive pulmonary disease (COPD). Clinical evidence from the SPARK trial suggests that TIO is superior to glycopyrronium (GLY), Seebri® Breezhaler®, in terms of severe exacerbations. This modeling study assessed the cost-effectiveness of TIO versus GLY for Canada (CAN), Spain (ESP), Sweden (SWE), and the UK, making use of this new clinical evidence.
Methods: A Markov cohort model, with moderate to very severe (Global Initiative for Chronic Obstructive Lung Disease II–IV) COPD patients, was populated with efficacy data from the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) and SPARK trials as well as costs, utilities, and epidemiological data relevant for each country. Treatment efficacy was modeled as improvements in lung function, quality-adjusted life years (QALYs), and as a lowering of the risk of exacerbations (rate of exacerbations). Risks of exacerbations differed between cohorts based on data from SPARK. Health and cost outcomes were simulated over an approximate lifetime horizon, starting from the age of 65 years. Robustness of results was validated in deterministic sensitivity analyses.
Results: Over the lifetime horizon, patients treated with TIO accumulated −623 (CAN), 1,066 (ESP), 1,137 (SWE), and −169 (UK), respectively, in incremental costs (€2014). TIO generated better health outcomes compared to GLY in all countries, 0.21 (CAN), 0.25 (ESP), 0.23 (SWE), and 0.23 (UK) in incremental QALYs. The cost per QALY gained was found to be €4,281 and €1,137 for ESP and SWE, respectively, while TIO was found to be cost saving in CAN and the UK. The results were mainly driven by the relative risk of severe exacerbations found in SPARK (GLY/TIO relative risk: 1.43, 95% confidence interval: 1.05–1.97, P=0.025).
Conclusion: The results from this study show that TIO is a cost-effective treatment compared to GLY in moderate to very severe COPD. The cost per QALY is well below the existing implicit and explicit willingness-to-pay thresholds.

Keywords: COPD, exacerbations, tiotropium, glycopyrronium, cost-effectiveness, Markov cohort model

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