OBJECTIVES

This study evaluated the cost-effectiveness of 6 recommended treatment strategies for the patients with Chronic obstructive pulmonary disease (COPD) in China.

METHODS

: A Markov model was developed to simulate the progression of COPD under different treatment strategies during lifetime by 3-month cycle. Key treatment adverse events were also modeled, including death, acute hospital exacerbation, acute complications and chronic complications. Model was stratified by COPD severity (mild, moderately severe and very severe). The transition probabilities, clinical inputs and the utility values were extracted from the updated information of UK NICE COPD guideline (NG115). The cost data of Chinese COPD patients were extracted from a proprietary Chinese hospital database which contains both outpatient and inpatient data from more than 3000 major hospitals in China (ADEN). During the simulation, both costs and utilities were annually depreciated at the rate of 3.5%. The model was also validated against the observed values from ADEN to assure validity.

RESULTS

: Consistently with other countries, O5 strategy [LABA(Long acting β2 receptor agonist)+ICS(Inhaled corticosteroid) followed by Triple treatment] is shown as the most effective treatment strategy, offering the most quality adjusted life years among all tested strategies for most people. Due to the lower costs associated with LABA + ICS in China, O2 strategy [LAMA(Long acting anticholinergic antagonist) followed by LABA+ICS followed by Triple treatment] could be more cost effective for young and mild patients. The key model results predicted on the population level were close to the averages of respective observed values of COPD patients (N=14,162,347) on ADEN: 5-year death rate (21.51% vs. 19.68%), annual hospital exacerbation rate (16.10% vs. 16.59%), and annual inpatient costs (RMB 10,697.59 vs. 9,384.04).

CONCLUSIONS : O5 strategy is the most effective treatment strategy for most Chinese COPD patients, while O2 strategy could be more cost effective for young and mild patients.