Institute for Medical Technology Assessment/Institute for Healthcare Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Pharmacoeconomics. 2012 Apr;30(4):271-302. doi: 10.2165/11589270-000000000-00000.
Over 200 million people have chronic obstructive pulmonary disease (COPD) worldwide. The number of disease-year equivalents and deaths attributable to COPD are high. Guidelines for the pharmacological treatment of the disease recommend an individualized step-up approach in which treatment is intensified when results are unsatisfactory.
Our objective was to present a systematic review of the cost effectiveness of pharmacological maintenance treatment for COPD and to discuss the methodological strengths and weaknesses of the studies.
A systematic literature search for economic evaluations of drug therapy in COPD was performed in MEDLINE, EMBASE, the Economic Evaluation Database of the UK NHS (NHS-EED) and the European Network of Health Economic Evaluation Databases (EURONHEED). Full economic evaluations presenting both costs and health outcomes were included.
A total of 40 studies were included in the review. Of these, 16 were linked to a clinical trial, 14 used Markov models, eight were based on observational data and two used a different approach. The few studies on combining short-acting bronchodilators were consistent in finding net cost savings compared with monotherapy. Studies comparing inhaled corticosteroids (ICS) with placebo or no maintenance treatment reported inconsistent results. Studies comparing fluticasone with salmeterol consistently found salmeterol to be more cost effective. The cost-effectiveness studies of tiotropium versus placebo, ipratropium or salmeterol pointed towards a reduction in total COPD-related healthcare costs for tiotropium in many but not all studies. All of these studies reported additional health benefits of tiotropium. The cost-effectiveness studies of the combination of inhaled long-acting β₂-agonists and ICS all report additional health benefits at an increase in total COPD-related costs in most studies. The cost-per-QALY estimates of this combination treatment vary widely and are very sensitive to the assumptions on mortality benefit and time horizon.
The currently available economic evaluations indicate differences in cost effectiveness between COPD maintenance therapies, but for a more meaningful comparison of results it is important to improve the consistency with respect to study methodology and choice of comparator.
全球有超过 2 亿人患有慢性阻塞性肺疾病（COPD）。与 COPD 相关的疾病年数和死亡人数都很高。该疾病的药物治疗指南建议采用个体化逐步升级的方法，如果治疗效果不理想，则加强治疗。
本研究旨在对 COPD 的药物维持治疗的成本效益进行系统评价，并讨论研究的方法学优势和局限性。
对 MEDLINE、EMBASE、英国国家卫生服务体系经济评价数据库（NHS-EED）和欧洲卫生经济评价数据库网络（EURONHEED）中的药物治疗 COPD 的经济性评价进行了系统的文献检索。纳入了同时报告成本和健康结果的全经济性评价。
本研究共纳入 40 项研究。其中，16 项研究与临床试验相关，14 项研究采用 Markov 模型，8 项研究基于观察性数据，2 项研究采用其他方法。少数关于联合使用短效支气管扩张剂的研究一致发现，与单药治疗相比，联合治疗有净成本节约。比较吸入性皮质类固醇（ICS）与安慰剂或无维持治疗的研究结果不一致。比较氟替卡松与沙美特罗的研究一致发现，沙美特罗更具成本效益。噻托溴铵与安慰剂、异丙托溴铵或沙美特罗的成本效益研究表明，噻托溴铵可降低许多但并非所有研究中的 COPD 相关总体医疗成本。这些研究均报告了噻托溴铵可带来额外的健康获益。吸入性长效β₂-激动剂和 ICS 联合治疗的成本效益研究均报告了大多数研究中在增加 COPD 相关总成本的情况下可带来额外的健康获益。该联合治疗的成本-每质量调整生命年（QALY）估计值差异很大，且对死亡率获益和时间范围的假设非常敏感。
目前的经济性评价表明，COPD 维持治疗的成本效益存在差异，但为了更有意义地比较结果，重要的是要提高研究方法学和对照选择的一致性。
