Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium–olodaterol for patients with COPD in the Netherlands

Figures & data

Table 1 Cost parameters

Parameter	Value (€, 2014)	Source
Medication per pack
Tiotropium	41.27	Medicijnkosten.nl (accessed June 2015)
Tiotropium–olodaterol FDC	56.30	Medicijnkosten.nl (accessed June 2015)
COPD management
GOLD 2	712.42	Hettle et al^Citation52
GOLD 3	1,494.83	Hettle et al^Citation52
GOLD 4	2,468.59	Hettle et al^Citation52
Exacerbations
Nonsevere	177.35	Hettle et al^Citation52
Severe	5,600.19	Hettle et al^Citation52

Abbreviations: COPD, chronic obstructive pulmonary disease; FDC, fixed-dose combination; GOLD, Global initiative for chronic Obstructive Lung Disease.

Table 2 Cost-effectiveness results for the Netherlands (15-year time horizon)

	Undiscounted costs	Discounted costs	Undiscounted QALYs	Discounted QALYs
Tiotropium–olodaterol FDC	€32,423	€25,002	8.3787	7.6231
Tiotropium	€31,989	€24,494	8.3062	7.5506
Difference	€434	€508	0.0725	0.0726

Abbreviations: FDC, fixed-dose combination; QALYs, quality-adjusted life-years.

Table 3 Clinical outcomes

	Effects over 15 years				Effects over 1 patient year
	Life-years per patient	Exacerbation free months per patient per year	Nonsevere exacerbations per patient	Severe exacerbations per patient	Nonsevere exacerbations per patient year	Severe exacerbations per patient year	Total exacerbations per patient year
Tiotropium–olodaterol	11.184	11.21	5.337	3.185	0.477	0.285	0.762
Tiotropium	11.127	11.17	5.370	3.502	0.483	0.315	0.797
Difference	0.057	0.040	−0.033	−0.317	−0.006	−0.030	−0.035

Table 4 Sensitivity analyses

Variable	Mean (min; max)	ICER (min)	ICER (max)
Base case	All mean values	€6,930	€6,930
COPD-related mortality (RR)
Age <60 years, GOLD 2	1.73 (1.47; 1.98)	€4,673	€5,422
Age 60–69 years, GOLD 2	1.42 (1.20; 1.63)
Age ≥70 years, GOLD 2	1.09 (0.92; 1.25)
Age <60 years, GOLD 3	5.69 (4.83; 6.54)
Age 60–69 years, GOLD 3	2.20 (1.87; 2.53)
Age ≥70 years, GOLD 3	1.42 (1.21; 1.63)
Age <60 years, GOLD 4	15.52 (13.19; 17.85)
Age 60–69 years, GOLD 4	4.72 (4.01; 5.43)
Age ≥70 years, GOLD 4	2.99 (2.55; 3.44)
Lung function decline (mL)
GOLD 2	37.10 (31.54; 42.67)	€8,126	€2,536
GOLD 3	30.70 (26.10; 35.31)
GOLD 4	24.20 (20.57; 27.83)
Exacerbation risk
Risk nonsevere exacerbation	See Supplementary materials	€10,975	€8,415
Risk severe exacerbation	See Supplementary materials	Dominant	€13,150
Costs
Management GOLD 2 (monthly)	€59 (50; 68)	€7,522	€6,485
Management GOLD 3 (monthly)	€125 (106; 143)
Management GOLD 4 (monthly)	€206 (175; 237)
Nonsevere exacerbations	€177 (152; 204)	€6,984	€7,024
Severe exacerbations	€5,600 (4,760; 6,440)	€8,832	€5,175
Utilities
GOLD 2	0.787 (0.771; 0.802)	€4,080	€4,984
GOLD 3	0.750 (0.731; 0.768)
GOLD 4	0.647 (0.598; 0.695)
Nonsevere exacerbation (multiplier)	0.85 (0.72; 0.98)	€7,045	€6,963
Severe exacerbation (multiplier)	0.50 (0.43; 0.57)	€6,912	€7,098
Discount rate
Cost and QALYs	0%; 5%	€5,981	€7,365
Time horizon
52 weeks	–	€37,425
5 years	–	€6,784
10 years	–	€7,840
Lifetime	–	€11,464

Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global initiative for chronic Obstructive Lung Disease; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; RR, relative risk; min, minimum; max, maximum.

Figure 1 Probabilistic sensitivity analysis (100 iterations).

Abbreviations: QALYs, quality-adjusted life-year; Tio, Tiotropium; Olo, Olodaterol.

Figure 2 Cost-effectiveness acceptability curves.

Abbreviations: QALY, quality-adjusted life-year; Tio, Tiotropium; Olo, Olodaterol.

Figure 3 Total Dutch COPD health care costs with and without tiotropium–olodaterol FDC (in million Euros).

Notes: Blue: medication, green: management, orange: exacerbations.
Abbreviations: COPD, chronic obstructive pulmonary disease; FDC, fixed-dose dual bronchodilator combination.

Figure 4 Budget impact of introducing tiotropium–olodaterol FDC (in million Euros).

Abbreviation: FDC, fixed-dose dual bronchodilator combination.

HettleRWoutersHAyresJCost-utility analysis of tiotropium versus usual care in patients with COPD in the UK and BelgiumRespir Med2012106121722173323040833

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