OBJECTIVES: COPD is a chronic respiratory disease that is costly to the United States. For instance, the CDC estimated direct costs of COPD in 2010 to be $32 billion dollars. Accounting for indirect costs, such as lost days of work, costs rose to $52.4 billion dollars (Guarascio, 2013). Per 2010 data, 51% of these costs were paid by Medicare, 25% were paid by Medicaid, and 18% were covered by private insurance (CDC, 2022). As such, a cost-utility analysis was conducted to appropriately understand and contextualize the most effective ways to control COPD-related symptoms as well as accrued costs.

METHODS: A cost utility study using tertiary sources and 4-state Markov Modeling was conducted to compare Revefenacin to Tiotropium, a long-acting muscarinic antagonist which is the current standard of treatment. Data used was over a 3 to 5 year horizon. Principal summary measures and endpoints were: sustained improvements in patient FEV 1; number of adverse effects leading to exacerbations and hospitalizations, as well as total costs overeach patients treatment course.

RESULTS: Trials found that dosages of 88ug and 175ug were each extremely effective in improving FEV1 within the first 4 hours in 80% of patients. Further, Revefenacin was found to have less major cardiovascular risks, as well as less adverse effects than Tiotropium. Gathering and evaluation of relevant direct health costs (ambulance, admission costs, professional and lab services, drug costs) is ongoing.

CONCLUSIONS: Clinical trials have shown Revefenacin to be a superior medication in the treatment and control of COPD symptoms and exacerbations. However, as it is a newer medication (approved in 2018), it is likely to have a higher acquisition cost that current mainstays of treatment, such as tiotropium. As payer groups accrue the majority of costs, understanding the relationship between patient benefit (QALY), cost savings, and treatment effectiveness, are important considerations for formulary decision-makers.