Cost-Effectiveness Analysis of Long-Acting Bronchodilators for the Treatment of COPD (Moderate to Very Severe)

Abstract

Background: To evaluate the cost‐effectiveness of olodaterol once daily versus formoterol twice daily in patients with GOLD II‐IV chronic obstructive pulmonary disease (COPD) in Italy. Methods: A Markov decision model with 3‐month cycles and a lifetime horizon was adopted. There are a total of 10 health‐states in the model, including death. The other nine states correspond to combinations of one of three COPD severity stages (moderate, severe, and very severe COPD) and one of three levels of exacerbation severity (no exacerbation, non‐severe exacerbation, and severe exacerbation). Severity was based on post‐bronchodilator FEV1 and transitions were based on outcomes of two clinical trials, named 1222.13 and 1222.14, respectively. Utilities were derived from EQ‐5D scores evaluated in 1222.13 and 1222.14 clinical trials. Italian costs were obtained from literature and local sources. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Results: The incremental cost‐effectiveness ratio (ICER) of olodaterol was 5,657.83/QALY and 5,802.37/LY versus formoterol. Probability of olodaterol being cost‐effective at 40,000 per QALY/LY gained was 70%. Deterministic and probabilistic sensitivity analyses confirmed base case results. Conclusions: At a willingness to pay threshold of 40,000 per QALY/LY gained, olodaterol is cost‐effective versus formoterol in the treatment of patients with GOLD II‐IV COPD in Italy.