Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and brochodilators for severe and very severe COPD patients

Figures & data

Figure 1 Markov chain structure. Arrows represent the possible pathways of the disease course.

Table 1 Model initial population characteristics

	I: Mild	II: Moderate	III: Severe	IV: Very severe	Total	Source
% population	42%	41%	13%	4%	100%	Price et al 2004
Initial population	1,216,444	1,187,481	376,518	115,852	2,896,296
FEV1 (% predicted)	89.80%	63.70%	40.00%	26.20%		Antonelli-Incalzi et al 2003
Exacerbations/patient/year	0	0.8	1.8	2.6		Authors’ estimate from ISOLDE (Hankinson et al 1999; Burge and Wedzicha 2003)

Table 2 Main outcomes. Derived from Calverley et al (2003) and Szafransky et al (2003)

	C	SF (Calverley)	FB (Szafranski)	S (Calverley)	F (Calverley)
Exacerbation RR (vs placebo)		0.70	0.76	0.80	0.81
Symptom-free days	0%	14%	12%	3%	2%

Abbreviations: C, control; F, fluticasone alone; FB, formoterol/budesonide; RR, relative risk; S, salmeterol alone; SF, salmeterol/fluticasone.

Table 3 Direct and indirect costs. Derived from Lucioni et al (2005) and Dal Negro et al (2003b)

Costs (€/patient/year)
	Stage I	Stage II	Stage III	Stage IV
Direct cost independent of exacerbation	527.48	918.38	1592.59	3586.18
Direct cost per exacerbation		1219.46	1475.87	2637.33
Indirect cost independent of exacerbation		15.77	21.97	43.71
Indirect cost per exacerbation		27.81	38.76	77.10

Table 4 Model outcomes and costs (€) at the end of a life-long simulation (average values per patient)

Strategy	Exacerbation number	Symptom-free days	Direct cost	Indirect cost	Direct + Indirect cost
C	12.04	0	34,632.09	715.74	35,347.83
S	10.07	55	33,369.28	619.87	33,989.15
F	10.14	37	34,754.38	623.55	35,377.93
SF	9.09	257	34,037.71	571.93	34,609.64
FB	9.66	220	33,944.51	599.73	34,544.25

Abbreviations: C, control; F, fluticasone alone; FB, formoterol/budesonide; S, salmeterol alone; SF, salmeterol/fluticasone.

Figure 2 Cost and outcomes resulting from 1, 5, and 10 years, and life-long time horizon simulation.

Abbreviations: C, control; F, fluticasone alone; FB, formoterol/budesonide; S, salmeterol alone; SF, salmeterol/fluticasone.

Table 5 Incremental cost effectiveness ratio (ICER) calculation with respect to the less expensive strategy (S)

		Exacerbations per patient	Symptom-free days per patient	Direct cost per patient (€)
SF vs S	Difference	0.98	202	668.43
	ICER	679.55 (€/exacerbation)	3.31 (€/symptom-free day)
FB vs S	Difference	0.41	165	575.23
	ICER	1392.38(€/exacerbation)	3.48(€/symptom-free day)

Abbreviations: C, control; F, fluticasone alone; FB, formoterol/budesonide; RR, relative risk; S, salmeterol alone; SF, salmeterol/fluticasone.

Table 6 Base case and threshold values of model parameters that can cause strategy dominancy loss more rapidly

Parameter	Base value	Threshold value
Average initial population number of exacerbations/patient/year	0.67	0.59
Relative risk exacerbations	0.700	0.734
Hospitalization costs	€1862.00	€1584.00
Treatment pharmaceutical cost	€81.43	€91.28

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