Back to Journals » ClinicoEconomics and Outcomes Research » Volume 2

Evaluating the cost-effectiveness of tiotropium versus salmeterol in the treatment of chronic obstructive pulmonary disease

Authors Naik S, Kamal K, Keys PA, Mattei TJ

Published 9 March 2010 Volume 2010:2 Pages 25—36


Review by Single anonymous peer review

Peer reviewer comments 2

Shalini Naik, Khalid M Kamal, Patricia A Keys, Thomas J Mattei

Duquesne University School of Pharmacy, Pittsburgh, PA, USA

Objective: To assess the cost-effectiveness of 3 treatments (tiotropium, salmeterol, and no treatment) in patients with moderate chronic obstructive pulmonary disease (COPD).

Methods: A Markov model with a time horizon of 1 year was developed. A hypothetical cohort of 100,000 subjects with moderate COPD with mean age of 65 years, smoking history of 50 pack-years, and disease duration of 9.5 years were included in the model. The efficacy and withdrawal data were taken from published randomized clinical trials. The effectiveness measure was exacerbations avoided per patient per year. Incremental cost-effectiveness ratio (ICER) was calculated as additional cost per patient to prevent 1 exacerbation, compared with the next most expensive option. A payer’s perspective was used and only direct costs were included in the study. Sensitivity analyses were conducted to test the robustness of the baseline estimates and study assumptions.

Results: The mean annual costs for the no treatment, salmeterol, and tiotropium groups were $392.1, $1268.7, and $1408.6, respectively. The ICER of tiotropium compared with no treatment was $1817.36 per exacerbation avoided, while the ICER of salmeterol compared with no treatment was $2454.48 per exacerbation avoided. Thus, in patients with moderate COPD, tiotropium is more cost-effective than salmeterol and no treatment.

Keywords: cost-effectiveness, chronic obstructive pulmonary disease, markov model, tiotropium, salmeterol

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]