PURPOSE: Chronic obstructive pulmonary disease (COPD) is the fourth-leading cause of death in the United States (US). In addition to mortality, COPD exacerbations can result in substantial medical resource use. There are currently several treatments for COPD, including short-acting beta agonists, long-acting beta agonists, and inhaled corticosteroids.
METHODS: A decision-analytic model was constructed to examine the lifetime cost-effectiveness of salmeterol/fluticasone propionate (FSC), salmeterol (SAL),and fluticasone propionate (FP), salmeterol (SAL), fluticasone compared with placebo (PLA). All patients were able to take short-acting bronchodialators and anticholinergics. Disease severity, number and duration of exacerbation, and patient survival were obtained from a head-to-head, multicenter, randomized, double-blind controlled trial. Patients in the trial were adult patients between 40 and 85 years of age with an established history of COPD with a pre-bronchodilator FEV1 < 60% predicted at entry. Resource use, medical costs, and utility weights and costs were extracted from the published literature. Drug costs were taken from standard US published costing sources. Outcomes included number of exacerbations, symptom-free days, life-years, quality-adjusted life-years (QALY), and incremental cost per life-year or QALY. One-way and probabilistic sensitivity analyses were performed.
RESULTS: Compared to PLA, treatment with FSC was associated with an improvement in expected life-years (0.31) and QALY (0.20), where FP was not associated with an improvement in either. The incremental cost per QALY gained for FSC and SAL compared with PLA were $43,806/QALY and $16,732/QALY, respectively. Thus, treatment of COPD with FSC or SAL are cost-effective (assuming a $50,000/QALY threshold) compared to placebo.
CONCLUSION: FSC and SAL were found to reduce mortality and number of exacerbations and improve life-years and QALYs in patients with COPD compared to PLA or other therapies alone. Despite an increase in drug costs, treating COPD with FSC and SAL are cost-effective strategies compared with placebo.
CLINICAL IMPLICATIONS: Costs and benefits should be considered when choosing an appropriate treatment for patients with COPD.
DISCLOSURE: Christopher Blanchette, No Product/Research Disclosure Information; University grant monies NA; Grant monies (from sources other than industry) NA; Grant monies (from industry related sources) NA; Shareholder GlaxoSmithKline; Employee Employee of GlaxoSmithKline; Fiduciary position (of any organization, association, society, etc, other than ACCP NA; Consultant fee, speaker bureau, advisory committee, etc. NA; Other NA