institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
BMJ Open. 2021 Aug 4;11(8):e049675. doi: 10.1136/bmjopen-2021-049675.
Chronic obstructive pulmonary disease (COPD) guidelines advocate treatment with combinations of long-acting bronchodilators for patients with COPD who have persistent symptoms or continue to have exacerbations while using a single bronchodilator. This study assessed the cost-utility of the fixed dose combination of the bronchodilators tiotropium and olodaterol versus two comparators, tiotropium monotherapy and long-acting β2 agonist/inhaled corticosteroid (LABA/ICS) combinations, in three European countries: Finland, Sweden and the Netherlands.
A previously published COPD patient-level discrete event simulation model was updated with most recent evidence to estimate lifetime quality-adjusted life years (QALYs) and costs for COPD patients receiving either tiotropium/olodaterol, tiotropium monotherapy or LABA/ICS. Treatment efficacy covered impact on trough forced expiratory volume in 1 s (FEV), total and severe exacerbations and pneumonias. The unit costs of medication, maintenance treatment, exacerbations and pneumonias were obtained for each country. The country-specific analyses adhered to the Finnish, Swedish and Dutch pharmacoeconomic guidelines, respectively.
Treatment with tiotropium/olodaterol gained QALYs ranging from 0.09 (Finland and Sweden) to 0.11 (the Netherlands) versus tiotropium and 0.23 (Finland and Sweden) to 0.28 (the Netherlands) versus LABA/ICS. The Finnish payer's incremental cost-effectiveness ratio (ICER) of tiotropium/olodaterol was €11 000/QALY versus tiotropium and dominant versus LABA/ICS. The Swedish ICERs were €6200/QALY and dominant, respectively (societal perspective). The Dutch ICERs were €14 400 and €9200, respectively (societal perspective). The probability that tiotropium/olodaterol was cost-effective compared with tiotropium at the country-specific (unofficial) threshold values for the maximum willingness to pay for a QALY was 84% for Finland, 98% for Sweden and 99% for the Netherlands. Compared with LABA/ICS, this probability was 100% for all three countries.
Based on the simulations, tiotropium/olodaterol is a cost-effective treatment option versus tiotropium or LABA/ICS in all three countries. In both Finland and Sweden, tiotropium/olodaterol is more effective and cost saving (ie, dominant) in comparison with LABA/ICS.
慢性阻塞性肺疾病（COPD）指南提倡为 COPD 患者使用长效支气管扩张剂进行治疗，如果患者使用单一支气管扩张剂时仍存在持续性症状或持续发生加重，则可使用长效支气管扩张剂联合治疗。本研究评估了固定剂量的噻托溴铵和奥达特罗联合用药与两种对照药物，即噻托溴铵单药治疗和长效β2 激动剂/吸入性皮质类固醇（LABA/ICS）联合治疗，在芬兰、瑞典和荷兰这三个欧洲国家中的成本效用。
使用最新证据更新了之前发表的 COPD 患者水平离散事件模拟模型，以估算接受噻托溴铵/奥达特罗、噻托溴铵单药或 LABA/ICS 治疗的 COPD 患者的终生质量调整生命年（QALY）和成本。治疗效果涵盖了对谷值用力呼气量 1 秒（FEV1）、总加重和严重加重以及肺炎的影响。每个国家的药物、维持治疗、加重和肺炎的单位成本均已获得。国家特定分析分别遵守芬兰、瑞典和荷兰的药物经济学指南。
与噻托溴铵相比，噻托溴铵/奥达特罗治疗可获得 0.09（芬兰和瑞典）至 0.11（荷兰）的 QALY，而与 LABA/ICS 相比则可获得 0.23（芬兰和瑞典）至 0.28（荷兰）的 QALY。芬兰支付者的噻托溴铵/奥达特罗增量成本效果比（ICER）为 11000 欧元/QALY，而噻托溴铵则为 11000 欧元/QALY，与 LABA/ICS 相比则为优势。瑞典的 ICER 分别为 6200 欧元/QALY 和优势（基于社会视角）。荷兰的 ICER 分别为 14400 欧元和 9200 欧元（基于社会视角）。与噻托溴铵相比，在三个国家特定（非官方）的意愿支付阈值下，噻托溴铵/奥达特罗治疗的成本效益概率分别为 84%（芬兰）、98%（瑞典）和 99%（荷兰）。与 LABA/ICS 相比，这一概率在所有三个国家均为 100%。
基于模拟结果，与噻托溴铵或 LABA/ICS 相比，噻托溴铵/奥达特罗在所有三个国家均为一种具有成本效益的治疗选择。在芬兰和瑞典，与 LABA/ICS 相比，噻托溴铵/奥达特罗在有效性和成本节约方面均具有优势（即优势）。
