Cost-Effectiveness Analysis of Fixed-Dose Tiotropium/Olodaterol versus Tiotropium for COPD Patients in China

Figures & data

Figure 1 State transition diagram of Markov model.

Table 1 Baseline Characteristics

Baseline Characteristics	TIO 5 μg/Day	TIO/OLO FDC 5/5 μg/Day	Reference
Participants	4974	4968	[20]
Mean (SD) age, years	65.8 (8.6)	66.0 (8.5)	[20]
Male, n (%)	3596 (72.3)	3518 (70.8)	[20]
GOLD I, n (%)	21(0.4)	27(0.5)	[20]
GOLD II, n (%)	1953(39.3)	1850(37.2)	[20]
GOLD III, n (%)	2398(48.2)	2436(49.0)	[20]
GOLD IV, n (%)	595(12.0)	644(13.0)	[20]

Abbreviations: FDC, fixed-dose combination; GOLD II, moderate COPD; GOLD III, severe COPD; GOLD IV, very severe COPD; TIO, tiotropium bromide; TIO/OLO, tiotropium bromide/olodaterol.

Table 2 The Annual Transition Probabilities for TIO/OLO FDC and TIO

Severity Stage	TIO/OLO FDC Group	TIO Group	Reference
From stable GOLD II to stable GOLD III (first cycle)	0.031	0.038	[22,23]
From stable GOLD III to stable GOLD IV (first cycle)	0.03	0.041	[22,23]
From stable GOLD II to stable GOLD III (subsequent cycle)	0.026	0.026	[22,23]
From stable GOLD III to stable GOLD IV (subsequent cycle)	0.043	0.043	[22,23]
From stable GOLD II to severe exacerbation	0.06	0.07	[20]
From stable GOLD III to severe exacerbation	0.14	0.16	[20]
From stable GOLD IV to severe exacerbation	0.23	0.27	[20]
From stable GOLD II to non-severe exacerbation	0.43	0.53	[20]
From stable GOLD III to non-severe exacerbation	0.62	0.68	[20]
From stable GOLD IV to non-severe exacerbation	0.77	0.73	[20]

Abbreviations: FDC, fixed-dose combination; GOLD II, moderate COPD; GOLD III, severe COPD; GOLD IV, very severe COPD; TIO, tiotropium bromide; TIO/OLO, tiotropium bromide/olodaterol.

Table 3 COPD-Related Mortality Risk by Age and Severity Stage

Age	Patient Subgroup	Mortality in TIOSPIR (%/y)	Mortality in Chinese Research (%/y)	Ratio Compared to Chinese Data	Reference
60≤ Age<70	GOLD I~II	1.37	0.325	4.22	[24,25]
	GOLD III	2.13		6.55
	GOLD IV	4.56		14.03
Age ≥ 70	GOLD I~II	3.06	1.0511	2.91
	GOLD III	4.00		3.81
	GOLD IV	8.43		8.02

Abbreviations: GOLD I, mild COPD; GOLD II, moderate COPD; GOLD III, severe COPD; GOLD IV, very severe COPD.

Table 4 Health State-Related Utility and Exacerbation-Related Disutility

Parameter	Utility	Reference
Health state-related utility
GOLD II	0.776	Calculated form^Citation26,Citation27
GOLD III	0.677	Calculated form^Citation26,Citation27
GOLD IV	0.593	Calculated form^Citation26,Citation27
Exacerbation-related disutility(monthly)
Non-severe exacerbation	0.85	[28]
Severe exacerbation	0.5	[28]

Abbreviations: GOLD II, moderate COPD; GOLD III, severe COPD; GOLD IV, very severe COPD.

Table 5 Resource Use and Annual Costs for Markov Model

Parameter	Cost ($)	Reference
Drug costs
TIO/OLO FDC (5μg/5μg per day, $3.50/day)	1279.03	[29]
TIO (5μg per day, $2.52/day)	920.01	[29]
Management costs by COPD severity
GOLD II	1090.03	[30]
GOLD III	1485.40	[30]
GOLD IV	2246.02	[30]
Costs of exacerbations
Severe exacerbation in GOLD II	1165.52	[31]
Severe exacerbation in GOLD III	1491.69	[31]
Severe exacerbation in GOLD IV	1992.06	[31]
Non-severe exacerbation in GOLD II	84.87	[31]
Non-severe exacerbation in GOLD III	88.53	[31]
Non-severe exacerbation in GOLD IV	135.28	[31]
AEs treatment costs
Pneumonia	436.26	[30]
Nasopharyngi	14.54	[30]
Bronchitis	14.54	[30]
Upper respiratory tract infection	7.27	[30]

Abbreviations: FDC, fixed-dose combination; GOLD II, moderate COPD; GOLD III, severe COPD; GOLD IV, very severe COPD; TIO, tiotropium bromide; TIO/OLO, tiotropium bromide/olodaterol; AEs, adverse events.

Table 6 Cost-Effectiveness Analysis of Two Regimens Over 10 Years

	TIO/OLO FDC	TIO
Total Costs (C, $)	20,938.21	18,670.04
QALY	4.332	4.325
Life-year (LY)	6.655	6.667
Total exacerbations number	5.55	6.11
Non-severe	4.55	4.97
Severe	1.00	1.14
ICER
ΔC/ΔQALY	324,557.91
ΔC/ΔLY	TIO dominates

Abbreviations: FDC, fixed-dose combination; ICER, incremental cost-effectiveness ratio; LY, life-year; QALY, quality-adjusted life-year; TIO, tiotropium bromide; TIO/OLO, tiotropium bromide/olodaterol; ΔC, incremental costs; ΔQALY, incremental QALY; ΔLY, incremental LY.

Table 7 Model Outcomes versus TOnado Trial on TIO Arm

	Total Exacerbations per Patient-Year		All-Cause Mortality (%)
	TIO/OLO FDC	TIO	TIO/OLO FDC	TIO
TOnado /DYNAGITO, 1 year	0.68^Citation20	0.77^Citation20	2.72%^Citation13	3.07%^Citation13
Model, 1 year	0.555	0.611	3.2%	3.1%

Figure 2 Tornado diagram (ICER, TIO OLO FDC vs TIO).

Figure 3 Scatter plot of incremental cost-effective of TIO OLO FDC vs TIO.

Figure 4 Cost-effectiveness acceptability curve of TIO OLO FDC vs TIO.

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