Evidence map›Paper›PMID 29773969›Full record

ArticleCost effectiveness and resource allocation : C/E2018

Cost-effectiveness of umeclidinium compared with tiotropium and glycopyrronium as monotherapy for chronic obstructive pulmonary disease: a UK perspective.

Dhvani Shah, Maurice Driessen, Nancy Risebrough, Timothy Baker, Ian Naya, Andrew Briggs, Afisi S Ismaila

2 registry-linked trialsOpen access · goldAbstract read
In one paragraph

Article in Cost effectiveness and resource allocation : C/E, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.7field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT02207829 phase3completednot on this map

A Randomized, Blinded, Double-dummy, Parallel-group Study to Evaluate the Efficacy and Safety of Umeclidinium (UMEC) 62.5 mcg Compared With Tiotropium 18 mcg in Subjects With Chronic Obstructive Pulmonary Disease (COPD)

TypeinterventionalSponsorGlaxoSmithKlineRan2014 to 2015Enrolled1,017ConditionsPulmonary Disease, Chronic ObstructiveArmsUmeclidinium, Umeclidinium matching placebo, Tiotropium, Tiotropium matching placebo
NCT02236611 phase4completednot on this map

A Randomized, Parallel-group, Open-label Study to Evaluate the Efficacy and Safety of Umeclidinium (UMEC) 62.5 mcg Compared With Glycopyrronium 44 mcg in Subjects With Chronic Obstructive Pulmonary Disease (COPD)

TypeinterventionalSponsorGlaxoSmithKlineRan2014 to 2015Enrolled1,036ConditionsPulmonary Disease, Chronic ObstructiveArmsUmeclidinium, Glycopyrronium
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 5 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 4 countries.

Dhvani ShahICON Health Economics, ICON, New York, NY USA.
Maurice Driessen2Value Evidence & Outcomes, GSK, Brentford, Middlesex, UK.
Nancy RisebroughICON Health Economics, ICON, Toronto, ON Canada.
Timothy BakerICON Health Economics, ICON, New York, NY USA.
Ian Naya4Respiratory Medical Franchise, GSK, Brentford, Middlesex, UK.
Andrew Briggs5Health Economics & Health Technology Assessment Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Afisi S Ismaila6Value Evidence & Outcomes, GSK, 5 Moore Drive, PO Box 13398, Research Triangle Park, NC 27709-3398 USA.ORCID 0000-0002-2876-8308
The Institute of Conservation · GBGlaxoSmithKline (Germany) · DEHealth Economics and Outcomes Research (United Kingdom) · GBResearch Triangle Park Foundation · USUniversity of Glasgow · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective.

methodsA linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George's Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model.

resultsOver a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (- 0.053; 95% CI: - 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: - £645, - £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (- 0.033; 95% CI: - 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses.

conclusionsFor treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost.

Indexed as

Chronic obstructive pulmonary disorderCost-effectivenessEconomic evaluationLong-acting muscarinic antagonist

Identifiers

PMID29773969
PMCPMC5946544
OpenAlexW2799467144

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.