Using Cost-Effectiveness Analysis to Sharpen Formulary Decision-Making- The Example of Tiotropium at the Veterans Affairs Health Care System

Sep 1, 2008, 00:00
10.1111/j.1524-4733.2007.00314.x
https://www.valueinhealthjournal.com/article/S1098-3015(10)60579-7/fulltext
Title : Using Cost-Effectiveness Analysis to Sharpen Formulary Decision-Making- The Example of Tiotropium at the Veterans Affairs Health Care System
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(10)60579-7&doi=10.1111/j.1524-4733.2007.00314.x
First page :
Section Title :
Open access? : No
Section Order : 22

Objective

To identify a cost-saving subset of criteria for the use of tiotropium at a Veterans Affairs Medical Center based on a cost-effectiveness analysis with ipratropium as the comparator.

Methods

Retrospective analysis of electronic medical records for the calendar year 2004 was conducted. The sample was drawn from a population at the Baltimore Veterans Affairs Medical Center that had a confirmed diagnosis of chronic obstructive pulmonary disease (COPD) and had filled prescriptions for ipratropium. The tiotropium sample was based on a modeled cohort of COPD patients who had received tiotropium. The analysis was conducted from the perspective of the Veterans Affairs Health Care System. The outcome was the incremental cost-effectiveness of tiotropium versus ipratropium.

Results

The incremental cost-effectiveness ratio (ICER) was $2360 per avoided exacerbation. Tiotropium cost-effectiveness increased with COPD severity and was cost-saving in patients with very severe disease (ICER = $−1818) and in patients with a previous COPD-related hospitalization (ICER = $−4472). The ICER was most sensitive to the relative effectiveness and price of tiotropium. Results identified the levels of treatment effectiveness and price beyond which tiotropium would become cost-saving relative to ipratropium.

Conclusions

The results support the existing Veterans Affairs practice of offering tiotropium to patients with COPD-related hospitalizations. Periodic review of the effectiveness data to determine whether tiotropium would be cost-saving in patients with very severe COPD is suggested. Cost-effectiveness analyses that identify practical criteria-for-use should become an integral part of the formulary process.

Categories :
  • Cost/Cost of Illness/Resource Use Studies
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision Modeling & Simulation
  • Economic Evaluation
  • Retrospective Databases: Electronic Medical and Health Records, Admin Claims
  • Study Approaches
Tags :
  • chronic obstructive pulmonary disease
  • cost-effectiveness
  • formulary decision-making
  • tiotropium
  • veterans population
Regions :
  • North America
ViH Article Tags :