Table 4.
Main study characteristics of long-acting beta2 agonist/inhaled corticosteroid 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 |
|---|---|---|---|---|---|---|---|---|---|
| Altaf et al. 2015 (India) [27] | Prospective observational comparative study (CEA) | 6 months | None | 1. SF 2. FB 3. FF |
SF: Rs29,725 (€686) FB: Rs32,602 (€753) FF: Rs37,155 (€858) (No valuation year stated) |
Exacerbations (moderate + severe) SF: 1.2 + 0.43 FB: 1.4 + 0.50 FF: 1.5 + 0.63 |
2 vs. 1: Rs 37,781 (€872) per exacerbation avoided | SF and FB were the most effective strategies in the treatment of COPD, with a slight clinical superiority of SF | 23 |
| Stanciole et al. 2012 (sub-Saharan Africa & south-east Asia) [28] | Mathematical modelling study (CEA) | Lifetime | None | 1.Bronchodilator + corticosteroid (GOLD 3/4) 2. No treatment Five other (non-) pharmacologic interventions for different COPD sub-populations |
Africa: Int$749,047 Asia: Int$4,225,174 (2005) |
Annual DALYs saved per million Africa: 58 Asia: 370 |
Africa: $12,868 Asia: $11,424 Per DALY averted |
Cost effectiveness of bronchodilator + corticosteroid is close to the interventions in the optimal set | 64 |
| Roggeri et al. 2014 (Italy) [29] | Population-based, retrospective, observational study (CEA) | 1 year | AstraZeneca | 1. FB 2. SF |
1 vs. 2: −€499.90 (2013) |
COPD-related hospitalizations: −29.1 % Pneumonia-related hospitalizations: −42 % | Not provided | FB could lead to a cost reduction, with clinical improvement | 31 |
| Nielsen et al. 2013 (Scandinavia) [30] | Alongside RCT (CEA) | 3 months | AstraZeneca | 1. FB + tiotropium 2. Placebo + tiotropium |
Denmark: –€5 Finland: +€31 Norway: –€64 Sweden: –€9 (2010) |
Exacerbations: −0.19 | Societal/healthcare Denmark: dominant/€195 Finland: €149/€281 Norway: dominant/dominant Sweden: dominant/€141 per exacerbation avoided |
FB + tiotropium vs. placebo + tiotropium is cost effective in all four countries | 93 |
CEA cost-effectiveness analysis, COPD chronic obstructive pulmonary disease, DALY disability-adjusted life-year, FB formoterol/budesonide, FF formoterol/fluticasone, GOLD Global Initiative for COPD, ICER incremental cost-effectiveness ratio, ICS inhaled corticosteroids, LABA long-acting beta agonists, LAMA long-acting muscarinic antagonists, LYs life-years, QALYs quality-adjusted life-years, QHES Quality of Health Economic Studies, RCT randomized controlled trial, Rs Indian rupee, SF salmeterol/fluticasone