Modelling the 5-year cost effectiveness of tiotropium, salmeterol and ipratropium for the treatment of chronic obstructive pulmonary disease in Spain

作者：Molken Maureen P M H Rutten van^*; Oostenbrink Jan B; Miravitlles Marc; Monz Brigitta U

来源：The European Journal of Health Economics, 2007, 8(2): 123-135.

DOI：10.1007/s10198-007-0039-4

• chronic obstructive pulmonary disease (COPD)
• bronchodilators
• model
• cost effectiveness
• quality-adjusted life year (QALY)
• Spain

Our objective was to assess the 5-year cost effectiveness of bronchodilator therapy with tiotropium, salmeterol or ipratropium for chronic obstructive pulmonary disease (COPD) from the perspective of the Spanish National Health System (NHS). A probabilistic Markov model was designed wherein patients moved between moderate, severe or very severe COPD and had the risk of exacerbation and death. Probabilities were derived from clinical trials. Spanish healthcare utilisation, costs and utilities were estimated for each COPD and exacerbation state. Outcomes were exacerbations, exacerbation-free months, quality-adjusted life years (QALYs), and cost(-effectiveness). The mean (SE) 5-year number of exacerbations was 3.50 (0.14) for tiotropium, 4.16 (0.40) for salmeterol and 4.71 (0.54) for ipratropium. The mean (SE) number of QALYs was 3.15 (0.08), 3.02 (0.15) and 3.00 (0.20), respectively. Mean (SE) 5-year costs were sic6,424 (sic305) for tiotropium, sic5,869 (sic505) for salmeterol, and sic5,181 (sic682) for ipratropium (2005 values). Ipratropium, and tiotropium formed the cost-effectiveness frontier, with tiotropium being preferred when willingness to pay (WTP) exceeded sic639 per exacerbation-free month and sic8,157 per QALY. In Spain, tiotropium demonstrated the highest expected net benefit for ratios of the willingness to pay per QALY, well within accepted limits.

• 出版日期2007-6
• 单位河北医科大学