ArticleBMC pulmonary medicine2010
Tiotropium's cost-effectiveness for the treatment of COPD: a cost-utility analysis under real-world conditions.
Article in BMC pulmonary medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Tiotropium versus placebo for chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2014Pooled it
- Cost effectiveness of pharmacological maintenance treatment for chronic obstructive pulmonary disease: a review of the evidence and methodological issues.PharmacoEconomics · 2012Pooled it
- Methodology and results of real-world cost-effectiveness of carfilzomib in combination with lenalidomide and dexamethasone in relapsed multiple myeloma using registry data.The European journal of health economics : HEPAC : health economics in prevention and care · 2020Trial
- Extrafine beclometasone diproprionate/formoterol fumarate: a review of its effects in chronic obstructive pulmonary disease.NPJ primary care respiratory medicine · 2016Review
- Chronic obstructive pulmonary disease hospital admissions and drugs--unexpected positive associations: a retrospective general practice cohort study.NPJ primary care respiratory medicine · 2014Article
- Improving clinical reality in chronic obstructive pulmonary disease economic modelling : development and validation of a micro-simulation approach.PharmacoEconomics · 2013Article
- New clinical insights into chronic obstructive pulmonary disease and their implications for pharmacoeconomic analyses.PharmacoEconomics · 2012Review
- "Show me the money": a fair criticism of economic studies on inhaled bronchodilators for COPD.BMC pulmonary medicine · 2010Article
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4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTiotropium is reimbursed since March 2004 in Belgium for the treatment of Chronic Obstructive Pulmonary Disease (COPD). Questions however remain on this product's value for money. The purpose of this study is to calculate tiotropium's cost-effectiveness under real-world conditions.
methodsStrengths of both observational and RCT data were combined in a model. A large longitudinal (2002-2006) observational dataset of regular tiotropium users (56,321 patients) was analysed to retrieve the baseline risk for exacerbations and exacerbation-related hospitalisations the year before the first delivery of tiotropium. The relative treatment effect from the UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium) trial was then applied to this baseline risk to reflect the effect of tiotropium treatment and calculate the intervention's incremental cost-effectiveness ratio (ICER).
resultsAfter 1000 Latin Hypercube simulations, the incremental benefit expressed as quality-adjusted life years (QALY) gained is on average 0.00048 (95% confidence interval (CI) 0.00009-0.00092). In combination with a substantial mean incremental cost of €373 per patient (95% CI 279-475), this results in an unfavourable average ICER of €1,244,023 (95% CI 328,571-4,712,704) per QALY gained. Results were most sensitive to the treatment effect on hospitalisations. Based on our large observational database, up to 89% of the patients were not hospitalised for COPD in the year before the first tiotropium delivery.
conclusionsThe main cause for tiotropium's unfavourable cost-effectiveness ratio is a combination of a relative high price for tiotropium, a low number of hospitalisations without tiotropium treatment (on average 0.14/year) and a non-significant treatment effect (on average 0.94) with respect to avoiding exacerbation-related hospitalisations. From an economic point of view, a revision of reimbursement modalities (e.g. with a lower price) would be justified and would entail a more efficient use of resources.
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