OBJECTIVES: The objective of this study was to compare the cost-effectiveness of tiotropium + olodaterol (TIO/OLO) 5/5 µg versus aclidinium + formoterol (ACL/FOR) 400/12 µg for patients with chronic obstructive pulmonary disease (COPD) in the Iranian health care setting using a newly developed patient-level Markov model that reflects the current understanding of the disease.

METHODS: An individual-level Markov model was adapted to simulate 1000 patients with moderate-to-severe COPD using TreeAge pro 2018 software over a 5-year time horizon from the perspective of the Iranian National Health Service. Clinical data on lung-function improvement were obtained from a network meta-analysis and applied to mean baseline forced-expiratory-volume in 1 s (FEV1) for the first 24-weeks period. Natural history for lung-function decline was applied until the end of simulation. Exacerbation risk was estimated based on a random-effects logistic regression analysis. Mortality by age and disease stage was estimated from an analysis of TIOSPIR trial data. Cost of bronchodilators and other medications, routine management, and costs of treatment for exacerbations for the Iranian setting were included. Costs and effects were discounted at an annual rate of 5%. Uncertainty was assessed by deterministic and probabilistic sensitivity analysis.

RESULTS: TIO/OLO provided marginally higher costs ($24.97) and more QALYs (0.009), resulting in an incremental cost-effectiveness ratio of $2,684/QALY. Sensitivity analyses indicated that results were robust to key parameter variations, and the main drivers were: mean baseline forced expiratory volume in 1 second (FEV1), risk of exacerbation, FEV1 improvement from aclidinium–formoterol 400/12 µg, and lung-function decline. Probabilistic sensitivity analyses showed TIO/OLO to be the more cost-effective treatment in 73.2% of 1000 simulations at the threshold of %5,400 per QALY.

CONCLUSIONS: TIO/OLO can be considered a cost-effective bronchodilator compared with ACL/FOR in patients with moderate-to-severe COPD for the Iranian health care system.