Purpose The fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol

Purpose The fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol showed increased effectiveness concerning lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with the use of its mono-components. extrapolated to energy and survival, and treatment with tiotropiumColodaterol FDC was compared with tiotropium. CostCutility analysis was performed from your Dutch health care payers perspective using a 15-yr time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%). Both univariate and probabilistic level of sensitivity analyses were performed. Budget effect was yearly assessed over a 5-yr time horizon, taking into account different levels of medication adherence. Results As a result of cost raises, combined with quality-adjusted life-year (QALY) benefits, results showed that tiotropiumColodaterol FDC experienced an incremental cost-effectiveness percentage of 7,004/QALY. Without discounting, the incremental cost-effectiveness percentage was 5,981/QALY. Results were powerful in univariate and probabilistic level of sensitivity analyses. Budget effect Vitexicarpin supplier was estimated at 4.3 million over 5 years presuming 100% medication adherence. Scenarios with 40%, 60%, and 80% adherence resulted in lower 5-yr incremental cost increases of 1 1.7, 2.6, and 3.4 million, respectively. Summary TiotropiumColodaterol FDC can be considered a cost-effective treatment under current Dutch cost-effectiveness thresholds. Keywords: COPD, cost-effectiveness, health economics, costCutility, budget impact Intro The Global initiative for chronic Obstructive Lung Disease (Platinum) defines chronic obstructive pulmonary disease (COPD) like a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory airway response to noxious particles or gases.1 Exacerbations and comorbidities contribute to the overall severity of COPD. COPD has been projected to become the third largest cause of death by 2030, after malignancy and cardiovascular disease.2 While smoking is widely recognized as the major risk element for COPD, especially in developing countries, biomass smoke and indoor cooking food result in an increasing prevalence of COPD.3 Besides nonpharmacologic treatments, Vitexicarpin supplier several effective pharmacologic inhaled therapies for COPD are available. The main drug class to reduce symptoms and long term risk in moderate to very severe COPD is the class of long-acting bronchodilators, that is, long-acting beta-agonists (LABA) and long-acting muscarinic antagonists (LAMA). In individuals not sufficiently controlled with a single bronchodilator, a second bronchodilator of a different class may be added according to the Platinum recommendations. There seems a pharmacologic rationale for combining two classes of bronchodilators4 and some studies indeed showed the added value compared with the use of a single bronchodilator,5 but full synergistic effects have not been observed. In addition to Vitexicarpin supplier bronchodilators, inhaled corticosteroids (ICS) have been commonly used, often inside a fixed-dose combination (FDC) having a bronchodilator. Although ICS are considered the cornerstone pharmacologic treatment in asthma individuals, the use of ICS in individuals with COPD is definitely more controversial.6 ICS can have both systemic and local part effects7,8 and there seems limited added clinical value as compared with bronchodilators.9 Recently, the WISDOM study showed that ICS could be stepped down safely, that is, without increased exacerbation risk, as long as dual bronchodilators were continued.10 Spiolto Respimat? is definitely a once-daily dual bronchodilator consisting of the FDC of the LAMA tiotropium and the LABA olodaterol delivered through the Respimat? Soft Mist inhaler. Tiotropium has been utilized for over a decade and is among the most popular therapies for individuals with COPD. The performance, security, and cost-effectiveness of tiotropium have been evaluated in several large randomized controlled trials such as the UPLIFT and the POET.11C13 Due to its recent market introduction, so far only Rabbit polyclonal to TP53BP1 few studies have been performed with olodaterol; however, initial results seem beneficial with regard to its effectiveness,14,15 and its safety profile is comparable with existing LABAs.1 Recently, the FDC of tiotropium and olodaterol showed increased performance concerning lung function, physical functioning, and health-related quality of life compared with the use of its mono-components.16C18 Yet, while performance and security have been demonstrated, the cost-effectiveness of the new FDC is still unknown. In instances of an increasing burden of chronic diseases on governmental health care budgets, there is an obvious need for economic evaluation of newly available treatments. Therefore, the aim of this study was to assess the cost-effectiveness of tiotropiumColodaterol FDC in individuals with moderate to very severe COPD. Materials and methods Study design A costCutility analysis was performed, using an individual-level Markov model. A costCutility analysis is a special type of cost-effectiveness analysis that uses the quality-adjusted life-year (QALY) as end result measure. Type of model A deterministic.