Cost-effectiveness of combination therapy for chronic obstructive pulmonary disease.
Can Respir J
; 15(8): 437-43, 2008.
Article
in En
| MEDLINE
| ID: mdl-19107245
ABSTRACT
BACKGROUND:
There is evidence that combination therapy (CT) in the form of long-acting beta(2)-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).OBJECTIVE:
To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.METHODS:
A Markov model was designed to compare four treatment strategies no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV(1)] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV(1) less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality- adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.RESULTS:
CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.CONCLUSION:
Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV(1) worsens and reaches 50% of predicted values, CT is recommended.
Full text:
1
Database:
MEDLINE
Main subject:
Bronchodilator Agents
/
Markov Chains
/
Pulmonary Disease, Chronic Obstructive
Type of study:
Etiology_studies
/
Health_economic_evaluation
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Year:
2008
Type:
Article