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Respir Med ; 108(12): 1786-93, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25307414

RESUMEN

BACKGROUND: Indacaterol/glycopyrronium (IND/GLY) is a once-daily inhaled fixed-dose combination of indacaterol (IND), a long-acting ß2-adrenergic agonist (LABA), and glycopyrronium (GLY), a long-acting muscarinic antagonist (LAMA) for use as maintenance treatment to relieve symptoms of chronic obstructive pulmonary disease (COPD) in adults. OBJECTIVE: To determine the economic benefits of IND/GLY compared with the free combination of indacaterol and glycopyrronium (IND + GLY), and with the fixed-dose combination of salmeterol/fluticasone (SFC), in a moderate-to-severe COPD population with low-exacerbation risk. The model-based analysis extrapolated results up to lifetime time horizon and calculated costs per quality-adjusted life year. METHODS: Assuming equal efficacy, a cost-minimisation analysis compared IND/GLY vs IND + GLY using model inputs from the double-blind, randomised SHINE trial. The double-blind, randomised ILLUMINATE and TORCH trials were used to analyse cost-effectiveness versus SFC. To consider ICS-related pneumonia events, published odds ratio comparing an ICS-exposed group to a control group of COPD patients was used. Direct and indirect drug costs as well as drug acquisition costs (in Swedish Krona [SEK]) were derived from published Swedish sources. Cost and effects were discounted with 3%. Uncertainty was assessed by one-way and probabilistic sensitivity analyses (PSA). RESULTS: IND/GLY was cost-saving vs IND + GLY with incremental savings of SEK (EUR) 768 (85), and 3309 (368) per patient over one and five years. IND/GLY was found to be less costly and more effective compared to SFC with cost savings of SEK (EUR) 2744 (303), 8854 (976), 13,938 (1536), 27,495 (3031) and 43,033 (4744) over one, three, five, ten years and lifetime. The PSA indicated that all iterations produced dominant results for IND/GLY. CONCLUSION: IND/GLY is cost-minimising vs IND + GLY and dominates SFC in the maintenance treatment of COPD patients in Sweden. Encouraging dual bronchodilator therapy over an ICS-containing combination results in lower total costs and better outcomes compared to combination therapy including fluticasone in moderate-to-severe COPD patients with low exacerbation risk.


Asunto(s)
Broncodilatadores/economía , Glicopirrolato/economía , Indanos/economía , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Quinolonas/economía , Anciano , Albuterol/análogos & derivados , Albuterol/economía , Albuterol/uso terapéutico , Androstadienos/economía , Androstadienos/uso terapéutico , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Análisis Costo-Beneficio , Método Doble Ciego , Combinación de Medicamentos , Costos de los Medicamentos/estadística & datos numéricos , Quimioterapia Combinada , Femenino , Fluticasona , Volumen Espiratorio Forzado/efectos de los fármacos , Glicopirrolato/administración & dosificación , Glicopirrolato/uso terapéutico , Humanos , Indanos/administración & dosificación , Indanos/uso terapéutico , Masculino , Persona de Mediana Edad , Método de Montecarlo , Enfermedad Pulmonar Obstructiva Crónica/economía , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Quinolonas/administración & dosificación , Quinolonas/uso terapéutico , Xinafoato de Salmeterol , Suecia
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