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Canadian Respiratory Journal
Volume 15 (2008), Issue 8, Pages 437-443
Original Article

Cost-Effectiveness of Combination Therapy for Chronic Obstructive Pulmonary Disease

Anderson Chuck,1,2 Philip Jacobs,1,2 Irvin Mayers,3 and Darcy Marciniuk4

1Department of Public Health Sciences, University of Alberta, Canada
2Institute of Health Economics, University of Alberta, Edmonton, Alberta, Canada
3Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
4Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: There is evidence that combination therapy (CT) in the form of long-acting beta2-agonists (LABAs) and inhaled corticosteroids can improve lung function for patients with chronic obstructive pulmonary disease (COPD).

OBJECTIVE: To determine the cost-effectiveness of using CT in none, all or a selected group of COPD patients.

METHODS: A Markov model was designed to compare four treatment strategies: no use of CT regardless of COPD severity (patients receive LABA only); use of CT in patients with stage 3 disease only (forced expiratory volume in 1 s [FEV1] less than 35% of predicted); use of CT in patients with stages 2 and 3 disease only (FEV1 less than 50% of predicted); and use of CT in all patients regardless of severity of COPD. Estimates of mortality, exacerbation and disease progression rates, quality-adjusted life years (QALYs) and costs were derived from the literature. Three-year and lifetime time horizons were used. The analysis was conducted from a health systems perspective.

RESULTS: CT was associated with a cost of $39,000 per QALY if given to patients with stage 3 disease, $47,500 per QALY if given to patients with stages 2 and 3 disease, and $450,333 per QALY if given to all COPD patients. Results were robust to various assumptions tested in a Monte Carlo simulation.

CONCLUSION: Providing CT for COPD patients in stage 2 or 3 disease is cost-effective. The message to family physicians and specialists is that as FEV1 worsens and reaches 50% of predicted values, CT is recommended.