Economic evaluation of aclidinium bromide in the management of moderate to severe COPD: an analysis over 5 years

Abstract

Purpose

Aclidinium bromide is a long-acting muscarinic antagonistic used in maintenance treatment of chronic obstructive pulmonary disease (COPD). A model-based health economic study evaluated the cost-effectiveness of aclidinium 400 μg bid as an alternative to tiotropium 18 μg od for this indication in the US.

Patients and methods

Patient characteristics in this model reflect those in the aclidinium clinical studies: age >40 years, stable moderate-to-severe COPD, current or ex-smokers (>10 pack-years), post-salbutamol forced expiratory volume in 1 second (FEV₁) ≥30% and <80% of predicted normal value, and FEV₁/forced vital capacity <70%. The model consists of five main health states indicating severity of COPD and the level of utility, resource use, and costs. Treatment efficacy over 5 years was modeled using FEV₁% predicted; a network meta-analysis comparing aclidinium and tiotropium was used to estimate disease progression during the first 24 weeks, and results from the UPLIFT trial were used for time points after 24 weeks. Quality of life was assessed using utility scores in US patients from the UPLIFT trial. Cost-effectiveness was assessed as the incremental cost per quality-adjusted life year (QALY) gained.

Results

Over 5 years, QALYs were 3.50 for aclidinium versus 3.49 for tiotropium; life years accumulated were 4.52 for both. In this economic model, aclidinium versus tiotropium showed marginally fewer exacerbations (3.364 versus 3.390, respectively) and mean total health care costs (US$126,274 versus US$128,591, respectively). In all scenario analyses performed (discount factors of 0% and 6% for benefits and costs; time horizon of 1 year; mapping St George’s Respiratory Questionnaire to European Quality of Life–5 Dimensions; excluding pharmacy costs, COPD-related cost only; cost of exacerbations; including ACCORD II trial in the network meta-analysis), aclidinium was associated with lower costs and marginally greater QALYs versus tiotropium.

Conclusion

Aclidinium is potentially cost-effective compared with tiotropium for maintenance treatment of moderate-to-severe COPD.

Keywords:

• chronic obstructive pulmonary disease
• cost-effectiveness
• model
• tiotropium

Acknowledgments

The authors would like to acknowledge Shamika de Silva (Medical Writer, MAPI Consultancy) for assistance in drafting the manuscript as well as thank Prescott Medical Communications Group, Chicago, USA for additional editorial support. Financial assistance to support these services was provided by FRI.

Author contributions

All authors participated in the design and conduct of the study, as well as drafting and revising the manuscript. All authors have provided final approval of the submitted manuscript.

Disclosure

This study was conducted by Mapi HEOR and Strategic Market Access on behalf of Forest Research Institute, Inc. (FRI), a wholly owned subsidiary of Forest Laboratories, Inc., which funded the study and the preparation of this manuscript.

Michelle Mocarski is an employee of FRI. Andreas Karabis is an employee of Mapi and served as a paid consultant to FRI during the conduct of this study and the preparation of this manuscript. Indra Eijgelshoven and Gert Bergman worked for Mapi during the conduct of the study but are currently employed by AbbVie and Roche Diagnostics, respectively. AbbVie and Roche Diagnostics were not associated with this study.