Costa-Scharplatz Madlaina, Ställberg Björn, Goyal Pankaj, Asukai Yumi, Gruenberger Jean-Bernard, Price David
Novartis Pharma AB, Täby, Box 1150, 183 79, Stockholm, Sweden.
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
Appl Health Econ Health Policy. 2015 Dec;13(6):637-45. doi: 10.1007/s40258-015-0193-2.
The objective of this study was to compare the cost effectiveness of once-daily Seebri Breezhaler(®) (glycopyrronium bromide) 50 µg with Spiriva(®) (tiotropium bromide) 18 µg in the maintenance treatment of chronic obstructive pulmonary disease (COPD) in the Swedish setting.
A previously published COPD Markov model accounting for disease progression and treatment discontinuation was used. Disease progression included the annual decline in forced expiratory volume in the first second (FEV1) and occurrence of any exacerbations. Efficacy in the model consisted of FEV1 improvement between baseline and 12 weeks and the annual risk ratio of having an exacerbation compared to placebo. These clinical efficacy inputs were derived from a 1-year head-to-head trial comparing glycopyrronium 50 µg to tiotropium 18 µg. Utility values and cost estimates were obtained from the literature. The base-case analysis was performed for a 3-year time horizon. Cost and effects were discounted with 3% in accordance to Swedish guidelines. Uncertainty was assessed by one-way and probabilistic sensitivity analyses.
Glycopyrronium was found to be less costly and more effective than tiotropium in moderate to severe COPD patients with cost savings of 5197 Swedish kronor (€570, US$725) per patient over a 3-year time horizon. The probabilistic sensitivity analysis indicated that over 99% of the iterations produced dominant results for glycopyrronium.
Glycopyrronium bromide 50 µg once daily can be considered a cost effective alternative to tiotropium bromide 18 µg once daily in the maintenance treatment of COPD patients in Sweden.
本研究的目的是比较在瑞典环境下，每日一次使用50微克的Seebri Breezhaler（格隆溴铵）与每日一次使用18微克的Spiriva（噻托溴铵）在慢性阻塞性肺疾病（COPD）维持治疗中的成本效益。
使用先前发表的考虑疾病进展和治疗中断情况的COPD马尔可夫模型。疾病进展包括第一秒用力呼气量（FEV1）的年度下降以及任何急性加重的发生。模型中的疗效包括基线至12周期间FEV1的改善以及与安慰剂相比急性加重的年度风险比。这些临床疗效数据来自一项为期1年的50微克格隆溴铵与18微克噻托溴铵的头对头试验。效用值和成本估计来自文献。基础病例分析的时间跨度为3年。根据瑞典指南，成本和效果按3%进行贴现。通过单向和概率敏感性分析评估不确定性。
在中度至重度COPD患者中，发现格隆溴铵的成本低于噻托溴铵且效果更好，在3年时间跨度内每位患者可节省5197瑞典克朗（570欧元，725美元）。概率敏感性分析表明，超过99%的迭代结果显示格隆溴铵具有优势。结论：在瑞典，对于COPD患者的维持治疗，每日一次使用50微克格隆溴铵可被视为每日一次使用18微克噻托溴铵的一种具有成本效益的替代方案。
