Willson Jenny, Bateman Eric D, Pavord Ian, Lloyd Adam, Krivasi Tania, Esser Dirk
Health Economics and Outcomes Research, Real-World Evidence Solutions, IMS Health, 210 Pentonville Road, London, N1 9JY, UK.
Appl Health Econ Health Policy. 2014 Aug;12(4):447-59. doi: 10.1007/s40258-014-0107-8.
A considerable proportion of patients with asthma remain uncontrolled or symptomatic despite treatment with a high dose of inhaled glucocorticosteroids (ICSs) and long-acting β2-agonists (LABAs). Tiotropium Respimat(®) added to usual care improves lung function, asthma control, and the frequency of non-severe and severe exacerbations, in a population of adult asthma patients who are uncontrolled despite treatment with ICS/LABA.
This study estimated the cost effectiveness of tiotropium therapy as add-on to usual care in asthma patients that are uncontrolled despite treatment with ICS/LABA combination from the perspective of the UK National Health Service (NHS).
A Markov model was developed which considers levels of asthma control and exacerbations. The model analysed cost and quality-adjusted life-years (QALYs); sensitivity and scenario analyses were also conducted to test the robustness of the base case outcomes. All costs are given at 2012 prices.
The model found that in this category of asthma with unmet need, add-on tiotropium therapy generated an incremental 0.24 QALYs and £5,238 costs over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of £21,906 per QALY gained. Sensitivity analysis suggested that findings were most dependent on the costs of managing uncontrolled asthma and the cost of treatment with tiotropium.
In this modelled analysis of two clinical trials, tiotropium was found to be cost effective when added to usual care in patients who remain uncontrolled despite treatment with high-dose ICS/LABA. Further research should investigate the long-term treatment effectiveness of tiotropium.
尽管使用高剂量吸入糖皮质激素（ICS）和长效β2受体激动剂（LABA）进行治疗，但仍有相当一部分哮喘患者病情未得到控制或仍有症状。对于尽管接受了ICS/LABA治疗但病情仍未得到控制的成年哮喘患者群体，在常规治疗基础上加用噻托溴铵软雾吸入剂（Tiotropium Respimat®）可改善肺功能、哮喘控制情况以及非严重和严重发作的频率。
本研究从英国国家医疗服务体系（NHS）的角度，评估了在接受ICS/LABA联合治疗后仍未得到控制的哮喘患者中，加用噻托溴铵治疗作为常规治疗补充的成本效益。
建立了一个考虑哮喘控制水平和发作情况的马尔可夫模型。该模型分析了成本和质量调整生命年（QALY）；还进行了敏感性分析和情景分析，以检验基础病例结果的稳健性。所有成本均按2012年价格计算。
该模型发现，在这类有未满足需求的哮喘患者中，加用噻托溴铵治疗在其一生中可产生0.24个增量QALY，成本增加5238英镑，每获得一个QALY的增量成本效益比为21906英镑。敏感性分析表明，研究结果最依赖于管理未控制哮喘的成本和噻托溴铵治疗的成本。
在对两项临床试验的模拟分析中，发现对于尽管接受高剂量ICS/LABA治疗仍未得到控制的患者，加用噻托溴铵作为常规治疗具有成本效益。进一步的研究应调查噻托溴铵的长期治疗效果。
