COST-EFFECTIVENESS ANALYSIS OF TWO LONG-ACTING MUSCARINIC ANTAGONISTS FOR COPD TREATMENT IN SPAIN- UMECLIDINIUM VS. TIOTROPIUM (HO-17-18472)
Author(s)
Huerta A, Vallejo-Aparicio LA
GlaxoSmithKline, Tres Cantos (Madrid), Spain
OBJECTIVES: To estimate the incremental cost-effectiveness ratio (ICER) of the long-acting muscarinic antagonist umeclidinium compared with tiotropium, considered the standard of care for Chronic Obstructive Pulmonary Disease (COPD), from the Spanish National Health System (NHS) perspective. METHODS: The analysis was based on a head-to-head trial comparing changes from baseline in lung function (FEV) between umeclidinium 62.5mcg and tiotropium 18mcg, on a 12-week-period (Feldman G. et al. Int J Chron Obstruct Pulmon Dis 2016). A previously published linked equations cohort model, based on ECLIPSE and TORCH studies, which estimates COPD progression, exacerbation rates, associated healthcare-costs, quality-adjusted-life-years (QALYs) and survival, was used (Miravitlles M. et al. Int J Chron Obstruct Pulmon Dis 2016) of 30%-70% predicted and respiratory symptoms (mMRC dyspnoea scale ≥ 2) were included. Differential treatment effect was maintained until first year of analysis, based on a 52-weeks umeclidinium trial; subsequently no differences were assumed. Effectiveness was measured in QALYs, deriving utilities from a Spanish observational study. Direct-costs were obtained from local sources and treatments-costs from Spain retail prices for 2017 (€45.27 and €49.06 for umeclidinium and tiotropium respectively). Results were expressed as incremental costs per QALY gained (ICER), applying a 3% discount to costs and QALYs. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed. On DSA different discounts for tiotropium retail price were tested. RESULTS: At base-case umeclidinium was dominant over tiotropium, gaining 0.0135 QALYs with cost-savings of €192.20. DSA for tiotropium price showed that umeclidinium was cost-effective up to 36.3% tiotropium discount, as ICERs were below the accepted €30,000/QALY willingness-to-pay threshold in Spain. Varying main parameters in PSA did not have a significant impact on results. CONCLUSIONS: From the Spanish NHS perspective, umeclidinium is a dominant alternative to tiotropium, the standard of care for COPD.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PRS39
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Respiratory-Related Disorders