Cost-effectiveness of roflumilast as an add-on treatment to long-acting bronchodilators in the treatment of COPD associated with chronic bronchitis in the United Kingdom.

Abstract

OBJECTIVE:

To estimate the cost-effectiveness of adding a selective phosphodiesterase-4 inhibitor, roflumilast, to a long-acting bronchodilator therapy (LABA) for the treatment of patients with severe-to-very severe chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis with a history of frequent exacerbations from the UK payer perspective.

METHODS:

A Markov model was developed to predict the lifetime cost and outcomes [exacerbations rates, life expectancy, and quality-adjusted life years (QALY)] in patients treated with roflumilast, which showed a reduction in the exacerbation rates and lung function improvement in a pooled analysis from two clinical trials, M2-124 and M2-125. Sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness.

RESULTS:

The addition of roflumilast to concomitant LABA reduced the number of exacerbations from 15.6 to 12.7 [2.9 (95 % CI 0.88-4.92) exacerbations avoided] and increased QALYs from 5.45 to 5.61 [0.16 (95 % CI 0.02-0.31) QALYs gained], at an incremental cost of £3,197 (95 % CI £2,135-£4,253). Cost in LABA alone and LABA + roflumilast were £16,161 and £19,358 respectively. The incremental cost-effectiveness ratios in the base case were £19,505 (95 % CI £364-£38,646) per quality-adjusted life-year gained and 18,219 (95 % CI £12,697-£49,135) per life-year gained. Sensitivity analyses suggest that among the main determinants of cost-effectiveness are the reduction of exacerbations and the case fatality rate due to hospital-treated exacerbations. Probabilistic sensitivity analysis suggests that the probability of roflumilast being cost-effective is 82 % at willingness-to-pay £30,000 per QALY.

CONCLUSIONS:

The addition of roflumilast to LABA in the treatment of patients with severe-to-very severe COPD reduces the rate of exacerbations and can be cost-effective in the UK setting.

• Authors: Yevgeniy Samyshkin, Robert W Kotchie, Ann-Christin Mörk, Andrew H Briggs, Eric D Bateman
• Journal: The European journal of health economics : HEPAC : health economics in prevention and care (Eur J Health Econ) Vol. 15 Issue 1 Pg. 69-82 (Jan 2014) ISSN: 1618-7601 [Electronic] Germany
• PMID: 23392624 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Aminopyridines
• Benzamides
• Bronchodilator Agents
• Cyclopropanes
• Delayed-Action Preparations
• Phosphodiesterase 4 Inhibitors
• Roflumilast

Topics

• Age Factors
• Aged
• Aminopyridines (administration & dosage, economics, therapeutic use)
• Benzamides (administration & dosage, economics, therapeutic use)
• Bronchitis (epidemiology)
• Bronchodilator Agents (administration & dosage, therapeutic use)
• Chronic Disease
• Clinical Trials as Topic
• Cost-Benefit Analysis
• Cyclopropanes (administration & dosage, economics, therapeutic use)
• Delayed-Action Preparations
• Female
• Health Services (economics, statistics & numerical data)
• Humans
• Male
• Markov Chains
• Middle Aged
• Phosphodiesterase 4 Inhibitors (administration & dosage, economics, therapeutic use)
• Pulmonary Disease, Chronic Obstructive (drug therapy, epidemiology)
• Quality-Adjusted Life Years
• Respiratory Function Tests
• United Kingdom