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 (original) (raw)
Samyshkin, Yevgeniy, Kotchie, Robert W., Mörk, Ann-Christin, Briggs, Andrew H. 
ORCID: https://orcid.org/0000-0002-0777-1997 and Bateman, Eric D.(2014) 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.European Journal of Health Economics, 15(1), pp. 69-82. (doi: 10.1007/s10198-013-0456-5) (PMID:23392624) (PMCID:PMC3889819)
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.| Item Type: | Articles |
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| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Briggs, Professor Andrew |
| Authors: | Samyshkin, Y., Kotchie, R. W., Mörk, A.-C., Briggs, A. H., and Bateman, E. D. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment |
| Journal Name: | European Journal of Health Economics |
| Publisher: | Springer Verlag |
| ISSN: | 1618-7598 |
| ISSN (Online): | 1618-7601 |
| First Published: | First published in European Journal of Health Economics 15(1):69-82 |
| Publisher Policy: | Reproduced under a Creative Commons License |
University Staff: Request a correction | Enlighten Editors: Update this record
Deposit and Record Details
| ID Code: | 90469 |
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| Depositing User: | Miss Fiona Doyle |
| Datestamp: | 03 Feb 2014 09:36 |
| Last Modified: | 23 Sep 2021 14:27 |
| Date of first online publication: | January 2014 |
| Date Deposited: | 15 December 2015 |