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Cost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countries
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2013 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, no 11, 1709-1721 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler(®)+tiotropium (TIO) HandiHaler(®) vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA).

METHODS: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial. The study included 659 patients with pre-bronchodilator forced expiratory volume in 1 s ≤ 50% and ≥1 exacerbation requiring systemic glucocorticosteroids or antibiotics the preceding year. Patients received BUD/FORM 320/9 μg bid + TIO 18 μg qd or PBO bid + TIO 18 μg qd. Effectiveness was defined as the number of severe exacerbations (hospitalisation/emergency room visit/systemic glucocorticosteroids) avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from CLIMB was combined with Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs (2010). The incremental cost-effectiveness ratios (ICERs) for BUD/FORM + TIO vs. PBO + TIO were estimated using descriptive statistics and uncertainty around estimates using bootstrapping. Analyses were conducted from the societal and healthcare perspectives in Denmark, Finland, Norway and Sweden.

RESULTS: From a societal perspective, the ICER was estimated at €174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 (€212), €307 and SEK 1573 (€165) per severe exacerbation avoided for Denmark, Finland and Sweden, respectively, while BUD/FORM + TIO was dominant in Norway. Including antibiotics decreased ICERs by 8-15%. Sensitivity analyses showed that results were overall robust.

CONCLUSION: BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries. (ClinicalTrials.gov Identifier: NCT00496470).

Place, publisher, year, edition, pages
2013. Vol. 107, no 11, 1709-1721 p.
Keyword [en]
Budesonide/formoterol, Tiotropium, Cost effectiveness, Nordic, COPD
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:umu:diva-99096DOI: 10.1016/j.rmed.2013.06.007ISI: 000327230800009PubMedID: 23856511Scopus ID: 2-s2.0-84887099441OAI: oai:DiVA.org:umu-99096DiVA: diva2:785828
Available from: 2015-02-04 Created: 2015-02-04 Last updated: 2017-12-05Bibliographically approved

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