Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
Suzhou Industrial Park Food and Drug Safety Inspection Team, Suzhou, Jiangsu 215000, China.
Can Respir J. 2022 Aug 25;2022:2878648. doi: 10.1155/2022/2878648. eCollection 2022.
Both long-acting muscarinic antagonists (LAMAs) and long-acting 2-agonists (LABAs) are widely used in the treatment of chronic obstructive pulmonary disease (COPD). A novel LAMA/LABA combination of umeclidinium/vilanterol (UMEC/VI; 62.5 g/25 g) is approved for chronic obstructive pulmonary disease (COPD) treatment.
This study aimed to assess the efficacy and cost-effectiveness of UMEC/VI versus tiotropium (TIO) 18 g in symptomatic patients with COPD from the perspective of the Chinese National Healthcare System.
A simple analysis included three studies in the meta-analysis that compared UMEC/VI with TIO. A Markov model was developed to estimate the cost-effectiveness of UMEC/VI compared with TIO treatment in symptomatic patients with COPD. First, utilities, clinical efficacy, and adverse events obtained from the literature were utilized as model inputs. Costs were from Chinese average data, including local data. Costs were expressed in dollars based on 2020 prices. Then, the model outputs including drug costs, other medical costs, and total costs, and quality-adjusted life years (QALYs) were estimated. Costs and outcomes were discounted at a 5% annual rate. Furthermore, incremental cost-effective ratios (ICERs) were analyzed. Finally, the influences of changing parameters on the uncertainty of the results were assessed by means of one-way and probabilistic sensitivity analyses.
This study revealed that UMEC/VI treatment had a higher rate of clinical efficacy in comparison with TIO, and the differences in the rate of adverse events between the two treatments were not significant. The results indicated that UMEC/VI was superior to TIO, which provided an increase in QALYs (0.002) and a total cost savings of $765.67 per patient over 3 years. In the base case, the ICER of UMEC/VI is -$397468.04/QALY compared with TIO, suggesting that UMEC/VI may be considered a dominant option over TIO. According to the Chinese medical system, the probability of UMEC/VI being cost-effective was 61.6% at a willingness-to-pay (WTP) of $31554/QALY. Sensitivity analyses confirmed that the results were robust.
UMEC/VI could be considered a cost-effective treatment compared with TIO in symptomatic COPD patients from the Chinese National Healthcare System perspective. These results may help decision-makers in China when making judgements on which treatments to administer.
长效毒蕈碱拮抗剂（LAMA）和长效 2 激动剂（LABA）均广泛用于治疗慢性阻塞性肺疾病（COPD）。乌美溴铵/维兰特罗（UMEC/VI；62.5μg/25μg）的新型 LAMA/LABA 联合制剂获批用于 COPD 治疗。
本研究旨在评估 UMEC/VI 与噻托溴铵（TIO）18μg 治疗 COPD 患者的疗效和成本效果，从中国国家医疗保健体系的角度进行评估。
简单分析包括荟萃分析中的三项研究，这些研究比较了 UMEC/VI 与 TIO。建立了一个 Markov 模型来估计 UMEC/VI 与 TIO 治疗 COPD 症状患者的成本效果。首先，使用文献中获得的效用、临床疗效和不良事件作为模型输入。成本来自中国平均数据，包括当地数据。成本以 2020 年的价格表示为美元。然后，估计模型输出包括药物成本、其他医疗成本和总成本以及质量调整生命年（QALY）。成本和结果以 5%的年率贴现。此外，还分析了增量成本效益比（ICER）。最后，通过单向和概率敏感性分析评估了参数变化对结果不确定性的影响。
本研究表明，与 TIO 相比，UMEC/VI 治疗的临床疗效更高，且两种治疗方法的不良事件发生率差异无统计学意义。结果表明，UMEC/VI 优于 TIO，UMEC/VI 治疗 3 年后每例患者的 QALY 增加 0.002，总成本节省 765.67 美元。在基准情况下，UMEC/VI 的 ICER 为-397468.04/QALY，与 TIO 相比，UMEC/VI 可能被认为是 TIO 的一种优势选择。根据中国医疗体系，UMEC/VI 的概率在 31554 美元/QALY 的意愿支付（WTP）下具有成本效益的概率为 61.6%。敏感性分析证实了结果的稳健性。
从中国国家医疗保健系统的角度来看，UMEC/VI 可能是治疗 COPD 症状患者的一种具有成本效益的治疗方法。这些结果可能有助于中国决策者在判断应给予哪些治疗时做出决策。
