Cost-Effectiveness Of Levofloxacin Inhalation Solution Vs. Aztreonam Inhalation Solution And Tobramycin Dry Powder For Inhalation In Cystic Fibrosis Patients In Sweden

Abstract

Objectives: To conduct an economic evaluation of Levofloxacin Inhalation Solution (LIS) compared to tobramycin in dry powder (TIP), and aztreonam lysine inhalation solution (AZLI) in Sweden for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis (CF) patients. Methods: A 24-week cycle Markov model was developed to estimate the expected costs and QALY gains over lifetime. The model simulated the disease progression of CF patients as measured by the decrease in FEV1 percent predicted. Lung transplantation and death were also integrated in the model. The base case analysis was conducted from both Swedish societal and health care perspectives at three time horizons (3-years, 5-years, and lifetime). Costs were in 2016 Swedish Kronor (1 SEK=0.11 Euro). Results: LIS was dominant vs. TIP over the three time horizons from the societal perspective and associated with a gain in QALYs of 0.168, 0.320 and 0.934 and cost saving of SEK 51,968, SEK 91,162 and SEK 127,075, respectively. From the health care perspective, LIS was cost-effective vs. TIP (at a cost-effectiveness threshold of SEK 500,000 per QALY), yielding ICERs of SEK 3,477, SEK 7,516 and SEK 190,316 over three time horizons, respectively. In addition, LIS was also dominant vs. AZLI in the full population over three studied time horizons from the societal perspective. It was associated with a predicted gain in QALYs of 0.115, 0.215 and 0.729 and cost savings, respectively. From the health care perspective, LIS was cost-effective compared to AZLI yielding ICERs of SEK 309,547, SEK 243,603 and SEK 348,375 over three time horizons, respectively. Conclusions: This model simulated the disease progression of CF patients as measured by the decrease in FEV1 percent predicted. LIS was found dominant compared with TIP and AZLI from the social perspective and cost-effective from the healthcare perspective at the cost-effectiveness threshold of SEK 500,000.