Economic evaluation of treating chronic obstructive pulmonary disease with inhaled corticosteroids and long-acting beta2-agonists in a health maintenance organization.

摘要

OBJECTIVES: In light of recent results from observational studies showing prolonged survival in subjects taking long-acting beta2-agonists (LABA) and/or inhaled corticosteroids (ICS) for chronic obstructive pulmonary disease (COPD), we investigated their cost-effectiveness (CE). METHODS: Costs and survival data were collected for a sample of members enrolled in a large Health Maintenance Organization in the United States. An observational study design was used to evaluate cumulative costs and health benefits of LABA, ICS, ICS+LABA, or comparison drugs. Survival was estimated using a parametric regression model. Costs were adjusted for censoring and prognostic factors. CE was evaluated over a time horizon of 36 months and the remaining lifetime of subjects. RESULTS: Over 36 months, life expectancy and costs were: 2.4 years (95% confidence interval (CI): 2.3; 2.5) and Dollars 28,030 (CI: Dollars 23,400; Dollars 33,570) for not receiving ICS or LABA; 2.6 years (CI: 2.6; 2.7) and Dollars 35,170 (CI: Dollars 29,970; Dollars 40,620) for ICS alone; 2.6 years (CI: 2.5; 2.7) and Dollars 27,380 (CI: Dollars 21,780; Dollars 32,510) for LABA alone; and, 2.7 years (CI: 2.6; 2.8) and Dollars 33,780 (CI: Dollars 28,700; Dollars 39,440) for subjects treated with ICS+LABA. The lifetime analysis showed similar trends. CONCLUSIONS: There is an acute need to find effective, life-extending treatments for persons with COPD. ICS, LABA or their combination represent promising treatment options and are currently being tested in randomized trials. If the impact on survival seen in these trials compares to that seen in observational studies, LABA and the combination treatment are likely to be cost-effective in the United States.