Cost-utility analysis of tiotropium versus usual care in patients with COPD in the UK and Belgium

Objective: To evaluate the cost-utility of adding tiotropium to usual care versus usual care alone for patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in the UK and Belgium. Methods: A four-state Markov model was developed with three disease severity states (moderate, severe, very severe) and death. Severity was based on post-bronchodilator FEV1 and transitions were based on outcomes of the Understanding Potential Long Term Impacts on Function with Tiotropium (UPLIFT (R)) trial. Utilities were derived from EQ-5D scores for a subset of UPLIFT (R) patients. UK costs were evaluated separately for England (E), and for Scotland, Wales and Northern Ireland (SWNI). Belgian (B) costs were obtained from local sources. Uncertainty was assessed by deterministic and probabilistic sensitivity analysis (PSA). Results: Adding tiotropium to usual care resulted in an incremental cost per patient of (sic)969 (B), 796 pound (E), and 812 pound (SWNI), and incremental QALYs of 0.052 (B), and 0.051 (E, SWNI). The four-year incremental cost-effectiveness ratios (ICER) were (sic)18,617 (B), 15,567 pound (E) and 15,890 pound (SWNI) per QALY. Probability of tiotropium being cost-effective at 30,000 pound ((sic)50,000) per QALY gained was greater than 60%. Conclusions: At willingness to pay thresholds of ((sic)) pound 30,000 per QALY gained, adding tiotropium to usual care is cost-effective. (C) 2012 Elsevier Ltd. All rights reserved.