TY - JOUR
T1 - Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study
AU - Briggs, A.H.
AU - Glick, H
AU - Lozano-Ortega, G
AU - Spencer, M
AU - Calverley, P
AU - Jones, P
AU - Vestbo, J
AU - TOwards a Revolution in COPD Health (TORCH) investigators
PY - 2009
Y1 - 2009
N2 - TORCH was a 3 year multi-centre trial of 6112 patients randomized to: salmeterol (SAL), fluticasone propionate (FP), the FP+SAL combination (SFC), or placebo (PL). Here we assess the cost-effectiveness of treatments evaluated in the TORCH study.Three year all-cause hospitalization, medication, and outpatient care costs were calculated for four regions. The sample was restricted to the 21 countries (n=4237) for which EQ-5D data were collected to estimate quality-adjusted life years (QALYs). Regression models were fitted to survival, study medication cost, other medication cost and EQ-5D data to estimate total cost, QALYs and cost-per-QALY adjusted for missing data and region.SFC had a trial-wide estimate of $43,600 cost per QALY compared with PL (95% CI: 21,400 to 123,500). Estimates for SAL vs. PL ($197,000) and FP vs. PL ($78,000) were less favorable. The US estimates were greater than other regions: for SFC vs. PL the cost-per QALY was $77,100 (46,200 to 241,700) compared to $24,200 (15,200 to 56,100) in Western Europe.Compared with PL, SFC has a lower incremental cost-effectiveness ratio than either FP or SAL used alone and is therefore preferred to these monotherapies on the grounds of cost-effectiveness.
AB - TORCH was a 3 year multi-centre trial of 6112 patients randomized to: salmeterol (SAL), fluticasone propionate (FP), the FP+SAL combination (SFC), or placebo (PL). Here we assess the cost-effectiveness of treatments evaluated in the TORCH study.Three year all-cause hospitalization, medication, and outpatient care costs were calculated for four regions. The sample was restricted to the 21 countries (n=4237) for which EQ-5D data were collected to estimate quality-adjusted life years (QALYs). Regression models were fitted to survival, study medication cost, other medication cost and EQ-5D data to estimate total cost, QALYs and cost-per-QALY adjusted for missing data and region.SFC had a trial-wide estimate of $43,600 cost per QALY compared with PL (95% CI: 21,400 to 123,500). Estimates for SAL vs. PL ($197,000) and FP vs. PL ($78,000) were less favorable. The US estimates were greater than other regions: for SFC vs. PL the cost-per QALY was $77,100 (46,200 to 241,700) compared to $24,200 (15,200 to 56,100) in Western Europe.Compared with PL, SFC has a lower incremental cost-effectiveness ratio than either FP or SAL used alone and is therefore preferred to these monotherapies on the grounds of cost-effectiveness.
U2 - 10.1183/09031936.00153108
DO - 10.1183/09031936.00153108
M3 - Journal article
C2 - 19717476
SN - 1399-3003
VL - 35
SP - 532
EP - 539
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 3
ER -