Earnshaw Stephanie R, Wilson Michele R, Dalal Anand A, Chambers Mike G, Jhingran Priti, Stanford Richard, Mapel Douglas W
RTI Health Solutions, Research Triangle Park, NC, USA.
Respir Med. 2009 Jan;103(1):12-21. doi: 10.1016/j.rmed.2008.10.005. Epub 2008 Nov 17.
We examine the lifetime cost-effectiveness of treatment with fluticasone propionate/salmeterol (500/50 microg) compared with no maintenance treatment in COPD in the US.
A decision-analytic model was developed to estimate lifetime costs and outcomes associated with fluticasone propionate/salmeterol 500/50 microg treatment, salmeterol 50 microg, and fluticasone propionate 500 microg compared to no maintenance treatment in treating COPD from a third-party US payer perspective. The patient population was similar to that of the TORCH clinical trial. Model structure and inputs were obtained from published literature and clinical trial data. All costs are presented in 2006 US dollars. Outcomes included cost per life year (LY) saved and cost per quality-adjusted life year (QALY) gained. Costs and outcomes were discounted at 3% annually. Univariate and multivariate sensitivity analyses were conducted to assess model robustness.
Compared to no maintenance treatment, treatment with fluticasone propionate/salmeterol 500/50mug results in a lifetime incremental cost-effectiveness ratio (ICER) of $33,865/QALY. Treatment with salmeterol 50 microg was found to have an ICER of $20,797/QALY. These results are robust to changes in input parameters. Fluticasone propionate 500 microg was dominated by no treatment, though the results were not robust to changes in parameters.
Treatment of COPD with fluticasone propionate/salmeterol 500/50 microg appears to be cost-effective (<or=$50,000/QALY) compared to no maintenance treatment. Similarly, salmeterol 50 microg may be cost-effective compared to no maintenance treatment. Compared with no maintenance treatment, fluticasone propionate 500 microg was effective in reducing number of exacerbations, but failure to differentiate from no maintenance treatment in mortality resulted in it being dominated in the base case.
我们在美国对丙酸氟替卡松/沙美特罗（500/50微克）治疗与慢性阻塞性肺疾病（COPD）不进行维持治疗的终身成本效益进行了研究。
建立了一个决策分析模型，从美国第三方支付方的角度估计与丙酸氟替卡松/沙美特罗500/50微克治疗、沙美特罗50微克和丙酸氟替卡松500微克治疗相比，在治疗COPD时不进行维持治疗所产生的终身成本和结果。患者群体与TORCH临床试验的患者群体相似。模型结构和输入数据来自已发表的文献和临床试验数据。所有成本均以2006年美元表示。结果包括每挽救一个生命年（LY）的成本和每获得一个质量调整生命年（QALY）的成本。成本和结果按每年3%进行贴现。进行了单变量和多变量敏感性分析以评估模型的稳健性。
与不进行维持治疗相比，丙酸氟替卡松/沙美特罗500/50微克治疗的终身增量成本效益比（ICER）为每QALY 33,865美元。发现沙美特罗50微克治疗的ICER为每QALY 20,797美元。这些结果对输入参数的变化具有稳健性。丙酸氟替卡松500微克治疗被不治疗所主导，尽管结果对参数变化不具有稳健性。
与不进行维持治疗相比，丙酸氟替卡松/沙美特罗500/50微克治疗COPD似乎具有成本效益（≤50,000美元/QALY）。同样，与不进行维持治疗相比，沙美特罗50微克可能具有成本效益。与不进行维持治疗相比，丙酸氟替卡松500微克在减少急性加重次数方面有效，但在死亡率方面未能与不进行维持治疗区分开来，导致其在基础病例中被主导。
