Abstract
Cost-effectiveness of tiotropium versus glycopyrronium in moderate to very severe COPD in France
OBJECTIVES: Tiotropium (TIO) is a long-acting anticholinergic (LAMA) for the treatment of moderate to very severe COPD. Evidence from a recent head-to-head trial, SPARK, suggests that TIO is superior to glycopyrronium (GLY) in preventing severe exacerbations. This study assessed the cost-effectiveness of TIO versus GLY for France in this setting.
METHODS: Treatment efficacy was modelled in a Markov cohort model as improvements in lung function, quality-adjusted life years and as a lowering of the risk of exacerbations (rate of exacerbations), by using best available clinical data for moderate to very severe (GOLD II – IV) COPD from the UPLIFT and SPARK trials. Mortality and cost inputs were obtained from relevant sources in France. Health and cost outcomes were simulated over an approximate life time horizon, starting from an age of 65 years and considering a societal perspective without indirect costs. Deterministic sensitivity analyses were performed.
RESULTS: Over a life time horizon, TIO resulted in an incremental cost of €2,138 and generated a better health outcome of 0.18 in incremental QALYs compared to GLY for the average COPD patient. The cost per QALY gained (ICER) was €11,880, which is lower than the acceptability thresholds mentioned in French and international studies. The price of tiotropium had a low impact on the ICER, a decrease in the price of 10%, 15% and 20% resulted in an 8%, 11% and 14% reduction in the ICER, respectively. The main driver of results was the relative risk of severe exacerbations found in SPARK (RR GLY/TIO: 1.43 CI 1.05-1.97, P = 0.025).
CONCLUSION: TIO is cost-effective versus GLY in moderate to very severe COPD in France.