OBJECTIVES

To assess the content and quality of recent pharmacoeconomic evaluations and Budget Impact Analyses (BIA) discussing maintenance treatments for COPD-patients, with a focus on the incorporation of real-world issues such as medication adherence, adverse drug reactions (ADRs) and co-morbidity.

METHODS

Systematic review was performed adhering to the PRISMA reporting items. The study protocol was published at PROSPERO (CRD42020167179). We searched MEDLINE in PubMed, Embase, and additional databases indexing economic evaluations, between 2016-2020, with no further restrictions. We extracted the main study characteristics and further elaborated on the real-world focus outcomes. The reporting quality was assessed by using the Quality of Health Economic Studies (QHES) instrument for economic evaluation and ISPOR Principles of Good Practice for BIAs.

RESULTS

The search highlighted 358 unique articles, from which 7,5% qualified for final analyses. We reviewed 20 economic evaluations, 6 BIAs and 2 articles including both types of analyses. Most of the articles (18) explored the effects of LABA/LAMA, followed by LAMA (3 articles), LABA/ICS (3 articles), LABA/LAMA/ICS (3 articles) and PDE4 inhibitors (1 article). The incremental outcomes all reflected dominance in the investigated treatments (all but one study was industry funded). The QALYs did not exceed 0,25 except for one study reporting higher QALY gains. The medication adherence was more likely to be included in the BIAs. Articles that accounted for co-morbidity mostly included cardiovascular conditions, a few discussed asthma, diabetes, depression or chronic bronchitis. Less than half of the studies accounted for ADRs, mainly pneumonia events. Quality assessment showed good quality reporting among the reviewed articles.

CONCLUSIONS

The investigated maintenance treatments for COPD-patients reflect favorable economic outcomes and budget impact. Yet, the pharmacoeconomic evaluations lack comprehensive inclusion of medication adherence, adverse drug reactions (ADRs) and co-morbidity.