Table 1.
Main study characteristics of long-acting muscarinic antagonist cost-effectiveness assessments
| Study, year (country) | Type of study | Time horizon | Funding | Drugs compared | Difference in total costs (year of valuation) | Difference in outcomes | ICER | Authors’ conclusion | QHES score |
|---|---|---|---|---|---|---|---|---|---|
| Costa-Scharplatz et al. 2015 (Sweden) [18] | Markov model (CUA) | 3 years (SA: 1 and lifetime) | Novartis | 1. Glycopyrronium 2. Tiotropium |
–5197 SEK (€570) (2013) | +0.005 QALYs, +0.001 LYs | Dominant | Glycopyrronium is cost saving | 94 |
| Eklund et al. 2015 (Sweden) [15] | Markov model (CUA) | Lifetime (SA: 5, 10 and 20 years) | Boehringer Ingelheim | 1. Tiotropium 2. Non-LAMA care 3. Glycopyrronium |
1 vs. 2: +15,041 SEK (€1,576) 1 vs. 3: +2423 SEK (€254) (2014) |
1 vs. 2: +0.07 QALYs, +0.08 LYs 1 vs. 3: +0.23 QALYs, +0.33 LYs |
1 vs. 2: 224,850 SEK (€23,569) per QALY 1 vs. 3: 10,546 SEK (€1105) per QALY |
Tiotropium is highly cost effective | 94 |
| Karabis et al. 2014 (USA) [19] | Time-in-state model (Markov like) (CUA) | 5 year (SA: 1 year) | Forest Laboratories | 1. Aclidinium 2. Tiotropium | −$US2317 (–€1802) (2012) | +0.0044 QALYs, 0.00 LYs | Dominant | Aclidinium is potentially cost effective | 84 |
| Zaniolo et al. 2012 (Italy) [14] | Markov model (CEA) | Lifetime | Boehringer Ingelheim | 1. Tiotropium + UC 2. UC |
+€3357 (2009) | +0.50 LYs, +0.42 QALYs, –0.79 exacerbations | €6698/LY, €7916/QALY, €4240/exacerbation avoided | Adding tiotropium to UC is good value for money | 80 |
| Hettle et al. 2012 (UK & Belgium) [16] | Markov model (CUA) | 4 years | Boehringer Ingelheim | 1. Tiotropium + UC 2. UC |
England: +£796 (€917) Belgium: +€969 (2011) |
England: +0.051 QALYs Belgium: +0.052 QALYs |
England: £15,567 (€17,936) /QALY Belgium: €18,617/QALY |
Adding tiotropium to UC is cost effective | 94 |
| Hoogendoorn et al. 2013 (Germany) [17] | Alongside 1-year RCT + 5-year model (CUA) | 1 and 5 years | Boehringer Ingelheim | 1. Tiotropium 2. Salmeterol |
Trial based: 1 year (PP): +€126 1 year (SP): +€170 Model based: 1 year (PP): +€116 5 year (PP): +€287 1 year (SP): +€190 5 year (SP): +€625 (2010) |
Trial based: −0.064 exacerbations Model based: 1 year: +0.012 QALYs 5 year: +0.082 QALYs |
Trial based: 1 year (PP): €1961 per exacerbation avoided 1 year (SP): €2647 per exacerbation avoided Model based: 1 year (PP): €9926 5 year (PP) €3488 per QALY 1 year (SP): €16,771 5 year (SP): €8141 per QALY |
Tiotropium can be considered cost effective | 81 |
CEA cost-effectiveness analysis, CUA cost-utility analysis, ICER incremental cost-effectiveness ratio, LYs life-years, PP payer’s perspective, QALYs quality-adjusted life-years, QHES Quality of Health Economic Studies, RCT randomized controlled trial, SA sensitivity analysis, SP societal perspective, UC usual care