Table 3.
Main study characteristics of phosphodiesterase-4 inhibitors (PDE-4) inhibitors cost-effectiveness assessments
| First author, year (country) | Type of study | Time horizon | Funding | Drug therapy described | Difference in total costs (year of valuation) | Difference in outcomes | ICER | Authors’ conclusion | QHES score |
|---|---|---|---|---|---|---|---|---|---|
| Samyshkin et al. 2014 (UK) [23] | Markov model (CUA) | Lifetime | Takeda | 1. LABA + roflumilast 2. LABA |
1 vs. 2: +£3197 (+€3656) (multiple years of valuation) | +0.164 QALYs +0.175 LYs |
£19,505 (€22,305) per QALY gained | Roflumilast as add-on to LABA can be cost effective in (very) severe COPD | 91 |
| Samyshkin et al. 2013 (Switzerland) [25] | Markov model (CUA) | Lifetime | Takeda | 1. Adding roflumilast to: a. LAMA, b. LABA/ICS, c. LAMA + LABA/ICS 2. a. LAMA, b. LABA/ICS, c. LAMA + LABA/ICS |
1a vs. 2a: +3390 CHF (€2815) 1b vs. 2b: +3308 CHF (€2747) 1c vs. 2c: +3799 CHF (€3155) (2011) |
1a vs. 2a: +0.347 LY/+0.275 QALY 1b vs. 2b: +0.364 LY/0.289 QALY 1c vs. 2c: +0.351 LY/+0.278 QALY |
1a vs. 2a: 12,313 CHF (€10,225) per QALY 1b vs. 2b: 11,456 CHF (€9513) per QALY 1c vs. 2c: 13,671 CHF (€11,353) per QALY |
Roflumilast is cost effective in patients with frequent exacerbations | 94 |
| Hertel et al. 2012 (UK) [26] | Markov model (CUA) | Lifetime | MSD | 1. Adding roflumilast to: LAMA + LABA/ICS 2. LAMA + LABA/ICS for ICS-tolerant and intolerant separately |
ICS-tolerant: +£414 (€447) ICS-intolerant: +£408 (€470) (2011) |
ICS-tolerant: +0.03 LY/+0.03 QALY ICS-intolerant: +0.04 LY/+0.03 QALY |
ICS-tolerant: £16,566 (€19,087) per QALY ICS-intolerant: £13,764 (€15,859) per QALY |
Roflumilast added to standard of care is cost effective for patients with severe COPD who continue to exacerbate despite bronchodilators | 85 |
| Nowak et al. 2013 (Germany) [22] | Markov model (CUA) | Lifetime | Nycomed | 1. Roflumilast + LABA 2. LABA |
+ €4500 (2011) | +0.234 QALY +0.257 LY –2.43 exacerbations |
€19,457 per QALY gained; €1852 per exacerbation avoided | Cost effectiveness of roflumilast as an add-on to LABA in patients with severe and very severe COPD is comparable to other treatments | 83.5 |
CHF Swiss franc, COPD chronic obstructive pulmonary disease, CUA cost-utility analysis, ICER incremental cost-effectiveness ratio, ICS inhaled corticosteroids, LABA long-acting beta agonists, LAMA long-acting muscarinic antagonists, LYs life-years, MSD Merck Sharp & Dohme, QALYs quality-adjusted life-years, QHES Quality of Health Economic Studies