PURPOSE: Chronic obstructive pulmonary disease (COPD) will be the fifth leading cause of disability-adjusted mortality by the year 2020. This leads to substantial humanistic and economic burden. Importantly, evidence continues to develop on the beneficial impact of inhaled corticosteroids (ICS) on outcomes in patients with COPD. The objective of this analysis was to estimate the cost-effectiveness of ICS in the treatment of patients with COPD.
METHODS: We used the Burden of Obstructive Lung Disease (BOLD) economic model which is a simulation model that was developed in order to estimate annual and future mortality and healthcare costs for patients with COPD. Data from Inhaled Steroid Effects Evaluation in COPD (ISEEC) study, an individual patient data meta-analysis of seven large randomized placebo-controlled trials investigating the effects of inhaled corticosteroids in COPD, were applied to the BOLD model from the perspective of a US population. Three scenarios were simulated: 1) ICS has an equal benefit on mortality across both GOLD stage II and stage III COPD; 2) there is an ICS-related differential mortality benefit between GOLD stage II and stage III; 3) there is an ICS-related differential mortality benefit between GOLD stage II and stage III and a benefit of reduced exacerbations. The simulations compared no ICS versus ICS in GOLD stages II and III by estimating cost-effectiveness ratios for ICS at year 5 and 20 of follow-up.
RESULTS: In the first scenario, cost-effectiveness per LYG was $29,064 at 5 years and $13,043 at 20 years. In the second scenario, these figures were $27,321 and $12,758, respectively. When ICS reduced the risk of mortality and the rate of exacerbations, as in the third scenario, the results were $1581 per LYG at 5 years and ICS were dominant (less costly and more effective) at 20 years.
CONCLUSION: The results from this analysis suggest that ICS treatment is a cost-effective alternative in patients with stage II and III COPD.
CLINICAL IMPLICATIONS: Over the long-term, ICS appear cost-effective in patients with stage II and stage III COPD.
DISCLOSURE: Todd Lee, Grant monies (from industry related sources) BOLD Project is sponsored by consortium of pharmaceutical manufacturers.