Long-term cost-effectiveness of the fixed-dose combination of tiotropium plus olodaterol based on the DYNAGITO trial results

Figures & data

Table 1 COPD-related health care use and unit costs for maintenance treatment for France

Maintenance costs	Country-specific annual mean	Non-country-specific annual mean	Unit costs (National Sickness Fund perspective)	Unit costs (societal perspective)	References
Treatment medication
Tiotropium + olodaterol	–	–	€1.30 per day	€1.60 per day	^Citation13
Tiotropium	–	–	€0.92 per day	€1.01 per day	^Citation13
Visits + other medication
Primary care visits (GP)	8.8	Equation in the model	€23.19 per visit	€26.07 per visit	^Citation14, ^Citation15
Specialist visits	1.1	Equation in the model	€52.05 per visit	€59.04 per visit	^Citation15, ^Citation16
Spirometries	1.4	–	€37.01 per spirometry	€41.57 per spirometry	^Citation16, ^Citation17
Influenza vaccination (%)	50.4%	–	€6.10 per vaccination	€6.10 per vaccination	^Citation13, ^Citation18
ICS use	–	Number of days alive if ICS at baseline	€1.17 per day	€1.30 per day	^Citation13

Abbreviations: –, not applicable; GP, general practitioner; ICS, inhaled corticosteroids.

Table 2 Exacerbation costs in France

Total costs	Moderate exacerbation	Severe exacerbation
National Sickness Fund perspective (below retirement age of 62 years)	€801	€7,504a
National Sickness Fund perspective (above retirement age of 62 years)	€801	€7,438
Societal perspective (below retirement age of 62 years)	€1,341b	€9,362c
Societal perspective (above retirement age of 62 years)	€866	€8,037

Notes: Data from Laurendeau et al.¹⁶

a Costs from Laurendeau et al’s study + (4.81–3 first days not paid=) 1.81 × daily allowances of €36.45 per day.

b Societal costs based on Laurendeau et al’s study + productivity loss as observed in the POET trial (1.73 days lost for a moderate exacerbation) multiplied with the costs of one day lost, €274.80.^22,23

c Societal costs based on Laurendeau et al’s study + productivity loss as observed in the POET trial (4.82 days lost for severe exacerbation), multiplied with the costs of 1 day lost, €274.80.^22,23

Table 3 Baseline characteristics of the 15,000 simulated patients of the model compared with the patients who participated in the DYNAGITO trial

	Model (15,000 sampled patients)	DYNAGITO trial (tiotropium arm)
Female, %	25.4	27.9
Age (years)	64.0	66.3
FEV1 (L)	1.19	1.20
FEV1% predicted	42	44
Low BMI (<21 kg/m^2), %	18.1	18.3a
Smokers, %	37.7	37.5
Pack-years	42.8	44.7
ICS users, %	62.8	70.1
Severe exacerbations in previous year, %	28.7	27.4
SGRQ total score (points)	47.5	47.4

Note:

a Approximated based on the mean BMI + SD.

Abbreviations: BMI, body mass index; ICS, inhaled corticosteroid; SGRQ, St George’s Respiratory Questionnaire.

Table 4 Lifetime model results for treatment with tiotropium + olodaterol vs with tiotropium monotherapy

	Tiotropium + olodaterol	Tiotropium
Severe exacerbation rate per year	0.163	0.187
Total exacerbation rate per year	0.724	0.786
Pneumonia per year	0.039	0.040
Remaining life-expectancy since start of the simulation (years)	9.94	9.84
Annual decline in lung function (mL)	−38.3	−38.3
Annual change in exercise capacity (seconds)	−4.4	−4.6
Annual change in physical activity (SGRQ activity score in points)	+1.52	+1.53
Percentage of time periods with cough/sputum, %	66.1	66.2
Percentage of time periods with breathlessness, %	70.5	70.9
Annual change in disease-specific quality of life (SGRQ total score in points)	+1.03	+1.04
Total number of QALYs (discounted)	4.80	4.76
Total lifetime costs from the National Sickness Fund perspective (discounted)	€22,161	€22,433
Total lifetime costs from the societal perspective (discounted)	€25,606	€25,483

Abbreviations: QALYs, quality-adjusted life-years; SGRQ, St George’s Respiratory Questionnaire.

Figure 1 Lifetime costs per patient specified by category for treatment with tiotropium + olodaterol (black bars) vs tiotropium monotherapy (gray bars) (discounted costs from the societal perspective).

Figure 2 CE plane for tiotropium + olodaterol vs tiotropium monotherapy based on discounted costs from the societal perspective.

Abbreviations: CE, cost-effectiveness; QALYs, quality-adjusted life-years.

Figure 3 Cost-effectiveness acceptability curve for the costs per QALY gained for tiotropium + olodaterol (solid line) vs tiotropium monotherapy (dashed line) based on discounted costs from the societal perspective.

Abbreviation: QALYs, quality-adjusted life-years.

Figure 4 Sensitivity analysis on cost per QALY gained for tiotropium + olodaterol vs tiotropium monotherapy based on discounted cost from the societal perspective (reference ICER of the main analysis: €2,900/QALY gained).

Abbreviations: ICER, incremental cost-effectiveness ratio; ICS, inhaled corticosteroids; QALYs, quality-adjusted life-years.

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