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Jackson D, Jenkins M, de Nigris E, Purkayastha D, Patel M, Ouwens M. Associations between the EQ-5D-5L and exacerbations of chronic obstructive pulmonary disease in the ETHOS trial. Qual Life Res 2024:10.1007/s11136-023-03582-z. [PMID: 38206455 DOI: 10.1007/s11136-023-03582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with deteriorating health and health-related quality of life (HRQoL) among people with COPD during and after events. HRQoL data are key to evaluating treatment cost-effectiveness and informing reimbursement decisions in COPD. EuroQoL 5-dimension 5-level (EQ-5D-5L) utility scores, based on various HRQoL measures, are used in economic evaluations of pharmacotherapy. These analyses estimated associations between EQ-5D-5L utility scores and exacerbations (new and previous) in patients with moderate-to-very severe COPD. METHODS Longitudinal mixed models for repeated measures (MMRM), adjusted for time and treatment, were conducted using data from the ETHOS study (NCT02465567); models regressed EQ-5D-5L on current and past exacerbations that occurred during the study, adjusting for other patient reported outcomes and clinical factors. RESULTS Based on the simplest covariate adjusted model (adjusted for current exacerbations and number of previous exacerbations during the study), a current moderate exacerbation was associated with an EQ-5D-5L disutility of 0.055 (95% confidence interval: 0.048, 0.062) with an additional disutility of 0.035 (0.014, 0.055) if the exacerbation was severe. After resolving, each prior exacerbation was associated with a disutility that persisted for the remainder of the study (moderate exacerbation, 0.014 [0.011, 0.016]; further disutility for severe exacerbation, 0.011 [0.003, 0.018]). CONCLUSION An EQ-5D-5L disutility of 0.090 was associated with a current severe exacerbation in ETHOS. Our findings suggest incorporating the effects of current, recently resolved, and cumulative exacerbations into economic models when estimating benefits and costs of COPD pharmacotherapy, as exacerbations have both acute and persistent effects.
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Patalano F, Hache C, Pethe A, Kaur H, Leidy NK, Arsiwala T, Afroz N, Gutzwiller FS. Performance of the Cough and Sputum Assessment Questionnaire (CASA-Q) in COPD: Evidence from Clinical and Online Patient Interaction Studies. Int J Chron Obstruct Pulmon Dis 2022; 17:3087-3096. [PMID: 36531977 PMCID: PMC9749416 DOI: 10.2147/copd.s381131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Patient perception of the burden of chronic bronchitis symptoms in chronic obstructive pulmonary disease (COPD) can be assessed using patient-reported outcome measures (PROMs). The Cough and Sputum Assessment Questionnaire (CASA-Q) was developed and tested for this purpose. This study reviewed the performance of the CASA-Q in published online studies and tested a novel approach to complement traditional methods of qualitative content validation. Methods A targeted literature search was performed to identify published clinical studies of COPD using the CASA-Q as an endpoint. The performance of the questionnaire was examined in relation to other study endpoints, including clinical and functional measurements and other PROMs. Assessment of the content validity of the CASA-Q was carried out by comparing the content and structure of the questionnaire with published qualitative patient data from previously conducted online social media listening (SML) and online bulletin board (OBB) studies. Results In the interventional clinical trials, CASA-Q change scores were consistent with study objectives and other endpoints, including FEV1 and other PROMs. Two observational studies showed cross-sectional correlations with other PROMs like the St.-George's Respiratory Questionnaire (SGRQ) and COPD assessment test (CAT) scores. Qualitative data from the SML and OBB patient studies were consistent with the content and structure of the CASA-Q, supporting the content validity of the measure. Conclusion Results suggest that the CASA-Q is appropriately responsive to changes in cough and sputum symptoms and clinical impact in trials of COPD. The mapping of qualitative findings from online SML and OBB studies to CASA-Q domains and items confirm the content validity of the instrument. These results suggest the CASA-Q can be a valuable tool for evaluating treatment effect in COPD trials.
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Affiliation(s)
- Francesco Patalano
- Pediatric and Patient Reported Outcomes Center of Excellence, Novartis Pharma AG, Basel, Switzerland
| | - Carolina Hache
- Regulatory Affairs, Novartis Pharma AG, Basel, Switzerland
| | - Abhijit Pethe
- Biostatistics, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Harneet Kaur
- Global Access Evidence, Novartis Pharma AG, Basel, Switzerland
| | | | - Tasneem Arsiwala
- Pediatric and Patient Reported Outcomes Center of Excellence, Novartis Pharma AG, Basel, Switzerland
| | - Nuzhat Afroz
- Patient Access Services, Novartis Healthcare Pvt Ltd, Hyderabad, India
| | - Florian S Gutzwiller
- Global Access Evidence, Novartis Pharma AG, Basel, Switzerland,Correspondence: Florian S Gutzwiller, HEOR & Access Evidence TA Head, Global Patient Access, Novartis Pharma AG, WSJ-188 6 001, Basel, CH-4056, Switzerland, Tel +41 616963713, Email
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Zafari Z, Li S, Eakin MN, Bellanger M, Reed RM. Projecting Long-term Health and Economic Burden of COPD in the United States. Chest 2020; 159:1400-1410. [PMID: 33011203 DOI: 10.1016/j.chest.2020.09.255] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the United States, COPD is a leading cause of mortality, with a substantial societal health and economic burden. With anticipated population growth, it is important for various stakeholders to have an estimate for the projected burden of disease. RESEARCH QUESTION The goal of this study was to model the 20-year health and economic burden of COPD, from 2019 to 2038, in the United States. STUDY DESIGN AND METHODS Using country-specific data from published literature and publicly available datasets, a dynamic open cohort Markov model was developed in a probabilistic Monte Carlo simulation. Population growth was modeled across different subgroups of age, sex, and smoking. The COPD prevalence rates were calibrated for different subgroups, and distributions of severity grades were modeled based on smoking status. Direct costs, indirect absenteeism costs, losses of quality-adjusted life years (QALYs), and number of exacerbations and deaths associated with COPD were projected. RESULTS The 20-year discounted direct medical costs attributable to COPD were estimated to be $800.90 billion (95% credible interval [CrI], 565.29 billion-1,081.29 billion), with an expected $337.13 billion in male subjects and $463.77 billion in female subjects. The 20-year discounted indirect absenteeism costs were projected to be $101.30 billion (70.82 billion-137.41 billion). The 20-year losses of QALYs, number of exacerbations, and number of deaths associated with COPD were 45.38 million (8.63 million-112.07 million), 315.08 million (228.59 million-425.33 million), and 9.42 million (8.93 million-9.93 million), respectively. The proportion of disease burden attributable to continued smoking was 34% in direct medical costs, 35% in indirect absenteeism costs, and 37% in losses of QALYs over 20 years. INTERPRETATION This study projects the substantial burden of COPD that the American society is expected to incur with current patterns for treatments and smoking rates. Mitigating such burden requires targeted budget appropriations and cost-effective interventions.
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Affiliation(s)
- Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.
| | - Shukai Li
- Industrial Engineering and Management Sciences, Northwestern University, Baltimore, MD
| | - Michelle N Eakin
- Division of Pulmonary Medicine, Johns Hopkins University, Baltimore, MD
| | - Martine Bellanger
- Department of Social Sciences, EHESP School of Public Health, Rennes, France; The Institut de Cancérologie de l'Ouest Comprehensive Cancer Center, Angers, France
| | - Robert M Reed
- Division of Pulmonary Medicine, University of Maryland School of Medicine, Baltimore, MD
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Park SK. Changes in symptoms and health-related quality of life in patients with exacerbated chronic obstructive pulmonary disease. Appl Nurs Res 2020; 54:151278. [PMID: 32650892 DOI: 10.1016/j.apnr.2020.151278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/14/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
AIMS To describe changes in symptoms and identify distinct subgroups of symptoms, to determine whether the sample's characteristics predicted changes in symptoms, and to examine how changes in symptoms predicted changes in health-related quality of life (HRQOL) over 6 months in patients with exacerbated chronic obstructive pulmonary disease (COPD). BACKGROUND Different patterns of changes in symptoms and their relationship to changes in HRQOL in patients with exacerbated COPD over long periods of time have been understudied. METHODS In this longitudinal study, participants with COPD (N = 42) had been admitted to a medical ward or had visited a pulmonary medicine clinic for treatment of exacerbation. Descriptive and inferential statistics were used to analyze data from questionnaires that assessed symptoms and HRQOL at baseline, daily symptoms over 6 months, and HRQOL at 6 months after exacerbation. RESULTS Not all participants experienced improved symptoms over time. Two sets of subgroups (improving &worsening; constantly better &constantly worse) emerged, based on 6-month changes in symptoms. Sample characteristics of the improving and worsening subgroups were similar, whereas usual dyspnea and HRQOL were significantly different in the constantly better and constantly worse subgroups. Little change in HRQOL was found in the total sample, but HRQOL deteriorated in the worsening subgroup, although deterioration was not meaningful. Changes in symptoms significantly predicted changes in HRQOL over 6 months. CONCLUSION Assessing patients' symptoms after exacerbations of COPD may enable health care providers to identify those at risk of future exacerbations and poorer HRQOL.0.
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Affiliation(s)
- Soo Kyung Park
- School of Nursing, Korea University, 145 Anam-Ro, Seongbuk-gu, Seoul, Republic of Korea (ROK).
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Measurement properties of preference-based measures for economic evaluation in COPD: a systematic review. Qual Life Res 2020; 29:2875-2885. [PMID: 32617890 DOI: 10.1007/s11136-020-02569-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Preference-based measures can provide measurements of health-related quality of life and be utilized for cost-effectiveness analyses of interventions in individuals with chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate whether generic preference-based measures are reliable, valid, and responsive in COPD. METHODS A systematic review was performed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. Three databases were searched: MEDLINE, EMBASE, and CINAHL. Studies were included if the sample represented individuals with COPD and the aim was to evaluate one or more psychometric properties or the interpretability of generic preference-based measures. RESULTS Six hundred and sixty-seven abstracts were screened, 65 full-text articles were reviewed and 24 articles met the inclusion criteria. Measures which emerged from the search were the EQ-5D, the SF-6D, the Quality of Well-being scale, the 15D, and the Health Utilities Index 3. Evidence for the test-retest reliability of these measures was limited. Construct validity of the measures was well supported with correlations with generic health profiles being 0.37-0.68, and correlations with COPD-specific health profiles being 0.53-0.75. Evidence for known-groups validity of these measures was poor and data on responsiveness were mixed. CONCLUSION Generic preference-based measures' sensitivity to change and ability to discriminate between different disease severities in COPD was poorly supported. Future research may consider examining the development of COPD-specific preference-based measures that may allow for a more accurate detection of change and discrimination among disease severities to facilitate cost-effectiveness evaluations.
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Zhang Y, Morgan RL, Alonso-Coello P, Wiercioch W, Bała MM, Jaeschke RR, Styczeń K, Pardo-Hernandez H, Selva A, Ara Begum H, Morgano GP, Waligóra M, Agarwal A, Ventresca M, Strzebońska K, Wasylewski MT, Blanco-Silvente L, Kerth JL, Wang M, Zhang Y, Narsingam S, Fei Y, Guyatt G, Schünemann HJ. A systematic review of how patients value COPD outcomes. Eur Respir J 2018; 52:13993003.00222-2018. [PMID: 30002103 DOI: 10.1183/13993003.00222-2018] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/21/2018] [Indexed: 01/06/2023]
Abstract
Our objective was to summarise systematically all research evidence related to how patients value outcomes in chronic obstructive pulmonary disease (COPD).We conducted a systematic review (systematic review registration number CRD42015015206) by searching PubMed, Embase, PsycInfo and CINAHL, and included reports that assessed the relative importance of outcomes from COPD patients' perspective. Two authors independently determined the eligibility of studies, abstracted the eligible studies and assessed risk of bias. We narratively summarised eligible studies, meta-analysed utilities for individual outcomes and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.We included 217 quantitative studies. Investigators most commonly used utility measurements of outcomes (n=136), discrete choice exercises (n=13), probability trade-off (n=4) and forced choice techniques (n=46). Patients rated adverse events as important but on average, less so than symptom relief. Exacerbation and hospitalisation due to exacerbation are the outcomes that COPD patients rate as most important. This systematic review provides a comprehensive registry of related studies.
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Affiliation(s)
- Yuan Zhang
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rebecca L Morgan
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain
| | - Wojtek Wiercioch
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Małgorzata M Bała
- Dept of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał R Jaeschke
- Section of Affective Disorders, Dept of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Styczeń
- Section of Affective Disorders, Dept of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | | | - Anna Selva
- Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí, Sabadell, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Spain
| | - Housne Ara Begum
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gian Paolo Morgano
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Marcin Waligóra
- REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Arnav Agarwal
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Ventresca
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karolina Strzebońska
- REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz T Wasylewski
- REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Lídia Blanco-Silvente
- TransLab Research Group, Dept of Medical Sciences, University of Girona, Girona, Spain
| | - Janna-Lina Kerth
- Dept for Medical Didactics and Curricular Development, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Mengxiao Wang
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuqing Zhang
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saiprasad Narsingam
- Dept of Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yutong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Gordon Guyatt
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Dept of Medicine, McMaster University, Hamilton, ON, Canada
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Oliveira AL, Marques AS. Outcome Measures Used in Pulmonary Rehabilitation in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review. Phys Ther 2018; 98:191-204. [PMID: 29228288 DOI: 10.1093/ptj/pzx122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Conflicting results about the effects of community-based pulmonary rehabilitation in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exist, possibly because the variety of outcome measures used and the lack of appropriate measurement properties hinder the development of pulmonary rehabilitation guidelines. PURPOSE The purpose of this study was to identify and review the measurement properties of patient-reported outcome measures (PROMs) and clinical outcome measures of AECOPD that are used in pulmonary rehabilitation and that can be easily applied in a community setting. DATA SOURCES PubMed, Web of Science, Scopus, and CINAHL were searched up to July 1, 2016. STUDY SELECTION Phase 1 identified outcome measures used in pulmonary rehabilitation for AECOPD. Phase 2 reviewed the measurement properties of the identified outcome measures. DATA EXTRACTION One reviewer extracted the data and 2 reviewers independently assessed the methodological quality of the studies and the measurement properties of the outcome measures by using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations. DATA SYNTHESIS Twenty-three PROMs and 18 clinical outcome measures were found. The outcome measures most used were the St George Respiratory Questionnaire (n = 15/37 studies) and the 6-minute walk test (n = 21/37 studies). Thirty-two studies described the measurement properties of 22 PROMs and 7 clinical outcome measures. The methodological quality of the studies was mostly poor, and the measurement properties were mostly indeterminate. The outcome measure exhibiting more robust properties was the COPD Assessment Test. LIMITATIONS A Number of studies were not found with the validated search strategy used and were included a posteriori; the fact that 3 studies presented combined results- for patients who were stable and patients with exacerbation-affected the conclusions that can be drawn. CONCLUSIONS A Large variety of outcome measures have been used; however, studies on their measurement properties are needed to enhance the understanding of community pulmonary rehabilitation for AECOPD.
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Affiliation(s)
- Ana L Oliveira
- Faculty of Sports, University of Porto, Porto, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), and Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Alda S Marques
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Agras do Crasto-Campus Universitário de Santiago, Edifício 30, 3810-193 Aveiro, Portugal; and Institute for Research in Biomedicine (iBiMED), University of Aveiro
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Poortinga W, Rodgers SE, Lyons RA, Anderson P, Tweed C, Grey C, Jiang S, Johnson R, Watkins A, Winfield TG. The health impacts of energy performance investments in low-income areas: a mixed-methods approach. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.ObjectivesTo determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.DesignA mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.SettingLow-income areas across Wales.ParticipantsResidents who received energy efficiency measures through the intervention programme and matched control groups.Main outcome measuresPrimary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.MethodsAnonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.Data sourcesThe Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.ResultsThe study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.LimitationsThis was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.ConclusionAlthough there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.Future workOur research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
| | - Sarah E Rodgers
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Chris Tweed
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Charlotte Grey
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Shiyu Jiang
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Rhodri Johnson
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Alan Watkins
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Thomas G Winfield
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
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Miravitlles M, Anzueto A. Chronic Respiratory Infection in Patients with Chronic Obstructive Pulmonary Disease: What Is the Role of Antibiotics? Int J Mol Sci 2017. [PMID: 28644389 PMCID: PMC5535837 DOI: 10.3390/ijms18071344] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Chronic infections are associated with exacerbation in patients with chronic obstructive pulmonary disease (COPD). The major objective of the management of these patients is the prevention and effective treatment of exacerbations. Patients that have increased sputum production, associated with purulence and worsening shortness of breath, are the ones that will benefit from antibiotic therapy. It is important to give the appropriate antibiotic therapy to prevent treatment failure, relapse, and the emergence of resistant pathogens. In some patients, systemic corticosteroids are also indicated to improve symptoms. In order to identify which patients are more likely to benefit from these therapies, clinical guidelines recommend stratifying patients based on their risk factor associated with poor outcome or recurrence. It has been identified that patients with more severe disease, recurrent infection and presence of purulent sputum are the ones that will be more likely to benefit from this therapy. Another approach related to disease prevention could be the use of prophylactic antibiotics during steady state condition. Some studies have evaluated the continuous or the intermittent use of antibiotics in order to prevent exacerbations. Due to increased bacterial resistance to antibiotics and the presence of side effects, several antibiotics have been developed to be nebulized for both treatment and prevention of acute exacerbations. There is a need to design long-term studies to evaluate these interventions in the natural history of the disease. The purpose of this publication is to review our understanding of the role of bacterial infection in patients with COPD exacerbation, the role of antibiotics, and future interventions.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), 08035 Barcelona, Spain.
| | - Antonio Anzueto
- Department of Medicine, Division of Pulmonary Diseases/Critical Care Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
- Pulmonary Section, The South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, Pulmonary Diseases Section (111E), 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA.
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Responsiveness of the EQ-5D to clinical change: is the patient experience adequately represented? Int J Technol Assess Health Care 2015; 30:10-19. [PMID: 24499622 DOI: 10.1017/s0266462313000640] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In many economic evaluations and reimbursement decisions, quality-adjusted life-years (QALYs) are used as a measure of benefit to assess effectiveness of novel therapies, often based on the EQ-5D 3-level questionnaire. As only five dimensions of physical and mental well-being are reflected in this tool, significant aspects of the patient experience may be missed. We evaluate the use of the EQ-5D as a measurement of clinical change across a wide range of disorders from dermatological (acne) to life-threatening (metastatic cancers). METHODS We analyze published studies on the psychometric properties of the EQ-5D 3-level questionnaire, extracting information on the Visual Analogue Scale versus Index score, Standardized Response Mean, and Effect Size. These are compared with ranges generally accepted to represent good responsiveness in the psychometric literature. RESULTS We find that only approximately one in five study populations report subjective health state valuation of patients within 5 percent of the score attributed by the EQ-5D index, and more than 40 percent of studies report unacceptable ceiling effects. In the majority of studies, responsiveness of the EQ-5D index was found to be poor to moderate, based on Effect Size (63 percent poor–moderate) and Standardized Response Mean (72 percent poor–moderate). CONCLUSIONS We conclude that the EQ-5D index does not adequately reflect patient health status across a range of conditions, and it is likely that a significant proportion of the subjective patient experience is not accounted for by the index. This has implications for economic evaluations of novel drugs based on evidence generated with the EQ-5D.
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Srivastava K, Thakur D, Sharma S, Punekar YS. Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. PHARMACOECONOMICS 2015; 33:467-488. [PMID: 25663178 DOI: 10.1007/s40273-015-0252-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND An understanding of the humanistic and economic burden of individuals with symptomatic chronic obstructive pulmonary disease (COPD) is required to inform payers and healthcare professionals about the disease burden. OBJECTIVES The aim of this systematic review was to identify and present humanistic [health-related quality of life (HRQoL)] and economic burdens of symptomatic COPD. METHODS A comprehensive search of online databases (reimbursement or claims databases/other databases), abstracts from conference proceedings, published literature, clinical trials, medical records, health ministries, financial reports, registries, and other sources was conducted. Adult patients of any race or gender with symptomatic COPD were included. Humanistic and economic burdens included studies evaluating HRQoL and cost and resource use, respectively, associated with symptomatic COPD. RESULTS Thirty-two studies reporting humanistic burden and 74 economic studies were identified. Symptomatic COPD led to impairment in the health state of patients, as assessed by HRQoL instruments. It was also associated with high economic burden across all countries. The overall, direct, and indirect costs per patient increased with an increase in symptoms, dyspnoea severity, and duration of disease. Across countries, the annual societal costs associated with symptomatic COPD were higher among patients with comorbidities. CONCLUSIONS Symptomatic COPD is associated with a substantial economic burden. The HRQoL of patients with symptomatic COPD is, in general, low and influenced by dyspnoea.
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Affiliation(s)
- Kunal Srivastava
- HERON Health PVT (Now Parexel), 3rd Floor, DLF Tower E, Rajiv Gandhi IT Park, Chandigarh, India
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Einarson TR, Bereza BG, Nielsen TA, Hemels MEH. Utilities for asthma and COPD according to category of severity: a comprehensive literature review. J Med Econ 2015; 18:550-63. [PMID: 25735652 DOI: 10.3111/13696998.2015.1025793] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are incurable diseases that impact quality-of-life. OBJECTIVE To summarize original research articles that measured or utilized preference-based utilities or disutilities according to disease severity. METHODS Medline and Embase were searched from inception until the end of November 2014. Two reviewers independently searched the literature with differences settled through discussion. Data extracted included utility scores as determined in original research categorized according to disease severity as well as disutilities associated with exacerbations or comorbidities. Data were tabulated and analyzed descriptively. RESULTS In total, 862 articles were identified, 790 were rejected, and 69 analyzed. There were 44 dealing with COPD and 25 with asthma. Average utilities determined by research were 0.828 ± 0.062, 0.765 ± 0.090, 0.711 ± 0.120, and 0.607 ± 0.120 for mild, moderate, severe, and very severe COPD, respectively. Utilities used in economic analyses were 0.866 ± 0.038, 0.770 ± 0.024, 0.739 ± 0.045, and 0.596 ± 0.075, respectively. Disutilities (annual) ranged from 0.002-0.378; major and minor exacerbations had respective disutilities of 0.287 and 0.108. For asthma patients, utilities were for 0.86 ± 0.32, 0.83 ± 0.065, and 0.74 ± 0.029, for mild, moderate, and severe disease, respectively. CONCLUSIONS Utilities have been summarized according to severity category of asthma and COPD. These values should be useful for researchers undertaking economic analyses of these diseases.
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Affiliation(s)
- Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
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Peters M, Crocker H, Dummett S, Jenkinson C, Doll H, Fitzpatrick R. Change in health status in long-term conditions over a one year period: a cohort survey using patient-reported outcome measures. Health Qual Life Outcomes 2014; 12:123. [PMID: 25113415 PMCID: PMC4243951 DOI: 10.1186/s12955-014-0123-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/04/2014] [Indexed: 12/21/2022] Open
Abstract
Background Enhancing quality of life for people with long-term conditions by monitoring patient-reported outcome measure scores is a key domain of health care policy. This study investigated the responsiveness of patient-reported outcome measures for long-term conditions. Methods A cohort survey was conducted in 33 primary care practices and 4485 patients (1334 asthma, 567 chronic obstructive pulmonary disease, 1121 diabetes, 525 epilepsy, 520 heart failure and 418 stroke) were sent a baseline survey containing a generic (EQ-5D) and a disease-specific measure. Baseline respondents were sent a follow-up after 1 year. Differences in scores for each long-term condition were assessed by paired t-tests. The relationship between scores and self-reported ‘change in health’ was assessed by analysis of variance. Results The baseline achieved a 38.4% response rate and the follow-up 71.5%. The only significant difference for the EQ-5D was found for the Visual Analogue Scale in heart failure between baseline and follow-up, and for change in health. Significant differences between baseline and follow-up scores were found on the disease-specific measures for 1 asthma dimension and 1 stroke dimension. No significant differences were found for other conditions. Significant differences between self-reported change in health and the disease-specific measures were found for 4 asthma dimensions and 2 stroke dimensions. Conclusions Few significant differences were found between the baseline and follow up or between ‘change in health’ and PROMs scores. This could be explained by the time frame of one year being too short for change to occur or by the PROMs not being responsive enough to change in a primary care sample. The latter is unlikely as the PROMs were in part chosen for their responsiveness to change. The baseline response rates may mean that the sample is not representative, and stable patients may have been more likely to participate. If PROMs are to be used routinely to monitor outcomes in LTCs, further research is needed to maximize response rates, to ensure that the PROMs used are reliable, valid and sensitive enough to detect change and that the time frame for data collection is appropriate. Electronic supplementary material The online version of this article (doi:10.1186/s12955-014-0123-2) contains supplementary material, which is available to authorized users.
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Miravitlles M, Anzueto A. Antibiotics for acute and chronic respiratory infection in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 188:1052-7. [PMID: 23924286 DOI: 10.1164/rccm.201302-0289pp] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prevention and effective treatment of exacerbations are major objectives in the management of patients with chronic obstructive pulmonary disease (COPD). Antibiotics are mainstay treatment for patients with severe COPD with an acute exacerbation that includes increased sputum purulence and worsening shortness of breath. Although such treatment is associated with clinical benefit, treatment failure and relapse rates may be high, particularly in cases of inadequate antibiotic therapy through incomplete resolution of the initial exacerbation and persistent bacterial infection. These aspects have led to recommendations for a stratified approach to antibiotic therapy based on patient characteristics associated with increased risk factors for failure. Patients at greatest risk for poor outcome (i.e., those with severe COPD) are likely to derive greatest benefit from early treatment with antibiotics. Long-term or intermittent antibiotic treatment has been shown to prevent COPD exacerbations and hospitalizations. These effects may be achieved by reducing bacterial load in the airways in stable state and/or bronchial inflammation. Although systemic antibiotics are likely to remain the core treatment for patients with moderate to severe exacerbated COPD, inhaled antibiotics may represent a more optimal approach for the treatment and prevention of COPD exacerbations in the future. Regardless of the route of administration, further studies are required to evaluate the potential long-term adverse events of antibiotics and the development of bacterial resistance.
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Affiliation(s)
- Marc Miravitlles
- 1 Pneumology Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; and
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Miravitlles M, García-Sidro P, Fernández-Nistal A, Buendía MJ, Espinosa de los Monteros MJ, Molina J. Course of COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores during recovery from exacerbations of chronic obstructive pulmonary disease. Health Qual Life Outcomes 2013; 11:147. [PMID: 23987232 PMCID: PMC3765881 DOI: 10.1186/1477-7525-11-147] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction COPD exacerbations have a negative impact on lung function, decrease quality of life (QoL) and increase the risk of death. The objective of this study was to assess the course of health status after an outpatient or inpatient exacerbation in patients with COPD. Methods This is an epidemiological, prospective, multicentre study that was conducted in 79 hospitals and primary care centres in Spain. Four hundred seventy-six COPD patients completed COPD assessment test (CAT) and Clinical COPD Questionnaire (CCQ) questionnaires during the 24 hours after presenting at hospital or primary care centres with symptoms of an exacerbation, and also at weeks 4–6. The scores from the CAT and CCQ were evaluated and compared at baseline and after recovery from the exacerbation. Results A total of 164 outpatients (33.7%) and 322 inpatients (66.3%) were included in the study. The majority were men (88.2%), the mean age was 69.4 years (SD = 9.5) and the mean FEV1 (%) was 47.7% (17.4%). During the exacerbation, patients presented high scores in the CAT: [mean: 22.0 (SD = 7.0)] and the CCQ: [mean: 4.4 (SD = 1.2)]. After recovery there was a significant reduction in the scores of both questionnaires [CAT: mean: -9.9 (SD = 5.1) and CCQ: mean: -3.1 (SD = 1.1)]. Both questionnaires showed a strong correlation during and after the exacerbation and the best predictor of the magnitude of improvement in the scores was the severity of each score at onset. Conclusions Due to their good correlation, CAT and CCQ can be useful tools to measure health status during an exacerbation and to evaluate recovery. However, new studies are necessary in order to identify which factors are influencing the course of the recovery of health status after a COPD exacerbation.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERS), Barcelona, Spain.
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Ghatnekar O, Bondesson Å, Persson U, Eriksson T. Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital. BMJ Open 2013; 3:bmjopen-2012-001563. [PMID: 23315436 PMCID: PMC3553390 DOI: 10.1136/bmjopen-2012-001563] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits. METHOD Published data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature. RESULTS The total cost for the LIMM model was €290 compared to €630 for standard care, in spite of a €39 intervention cost. The main cost offset arose from avoided drug-related readmissions in the Admission part (€262) whereas only €66 was offset in the Discharge part as a result of fewer outpatient visits and correction time. The reduced disutility was estimated to 0.005 quality-adjusted life-years (QALY), indicating that LIMM was a dominant alternative. The probability that the intervention would be cost-effective at a zero willingness to pay for a gained QALY compared to standard care was estimated to 98%. CONCLUSIONS The LIMM medication reconciliation (at admission and discharge) and medication review was both cost-saving and generated greater utility compared to standard care, foremost owing to avoided drug-related hospital readmissions. When implementing such a review process with a multidisciplinary team, it may be important to consider a learning curve in order to capture the full advantage.
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Affiliation(s)
- Ola Ghatnekar
- Swedish Institute for Health Economics, Lund, Sweden
| | - Åsa Bondesson
- Department of Medicines Management and Informatics, County of Skåne, Malmö, Sweden
| | - Ulf Persson
- Swedish Institute for Health Economics, Lund, Sweden
| | - Tommy Eriksson
- Department for Laboratory Medicine, Institution for Laboratory Medicine, Lund University,Lund, Sweden
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Mapel DW, Roberts MH. New clinical insights into chronic obstructive pulmonary disease and their implications for pharmacoeconomic analyses. PHARMACOECONOMICS 2012; 30:869-85. [PMID: 22852587 PMCID: PMC3625413 DOI: 10.2165/11633330-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death and disability worldwide, but before the development of several new pharmacological treatments little could be done for COPD patients. Recognition that these new treatments could significantly improve the prognosis for COPD patients has radically changed clinical management guidelines from a palliative philosophy to an aggressive approach intended to reduce chronic symptoms, improve quality of life and prolong survival. These new treatments have also sparked interest in COPD cost-effectiveness research. Most COPD cost-effectiveness studies have been based on clinical trial populations, limited to direct medical costs, and used standard analysis methods such as Markov modelling, and they have usually found that newer therapies have favourable cost effectiveness. However, new insights into the clinical progression of COPD bring into question some of the assumptions underlying older analyses. In this review, we examine clinical factors unique to COPD and recent changes in clinical perspectives that have important implications for pharmacoeconomic analyses. The main parameters explored include (i) the high indirect medical costs for COPD and their relevance in assessing the societal benefits of new therapy; (ii) the importance of acute deteriorations in COPD, known as exacerbations, and approaches to modelling the cost benefit of exacerbation reduction; (iii) quality/utility instruments for COPD; (iv) the prevalence of co-morbid conditions and confounding between COPD and co-morbid disease utilization; (v) the limitations of Markov modelling; and (vi) the problem of outliers.
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Affiliation(s)
- Douglas W Mapel
- Lovelace Clinic Foundation, Albuquerque, MN 87106-4264, USA.
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Rutten-van Mölken MPMH, Goossens LMA. Cost effectiveness of pharmacological maintenance treatment for chronic obstructive pulmonary disease: a review of the evidence and methodological issues. PHARMACOECONOMICS 2012; 30:271-302. [PMID: 22409290 DOI: 10.2165/11589270-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Over 200 million people have chronic obstructive pulmonary disease (COPD) worldwide. The number of disease-year equivalents and deaths attributable to COPD are high. Guidelines for the pharmacological treatment of the disease recommend an individualized step-up approach in which treatment is intensified when results are unsatisfactory. OBJECTIVE Our objective was to present a systematic review of the cost effectiveness of pharmacological maintenance treatment for COPD and to discuss the methodological strengths and weaknesses of the studies. METHODS A systematic literature search for economic evaluations of drug therapy in COPD was performed in MEDLINE, EMBASE, the Economic Evaluation Database of the UK NHS (NHS-EED) and the European Network of Health Economic Evaluation Databases (EURONHEED). Full economic evaluations presenting both costs and health outcomes were included. RESULTS A total of 40 studies were included in the review. Of these, 16 were linked to a clinical trial, 14 used Markov models, eight were based on observational data and two used a different approach. The few studies on combining short-acting bronchodilators were consistent in finding net cost savings compared with monotherapy. Studies comparing inhaled corticosteroids (ICS) with placebo or no maintenance treatment reported inconsistent results. Studies comparing fluticasone with salmeterol consistently found salmeterol to be more cost effective. The cost-effectiveness studies of tiotropium versus placebo, ipratropium or salmeterol pointed towards a reduction in total COPD-related healthcare costs for tiotropium in many but not all studies. All of these studies reported additional health benefits of tiotropium. The cost-effectiveness studies of the combination of inhaled long-acting β₂-agonists and ICS all report additional health benefits at an increase in total COPD-related costs in most studies. The cost-per-QALY estimates of this combination treatment vary widely and are very sensitive to the assumptions on mortality benefit and time horizon. CONCLUSIONS The currently available economic evaluations indicate differences in cost effectiveness between COPD maintenance therapies, but for a more meaningful comparison of results it is important to improve the consistency with respect to study methodology and choice of comparator.
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Affiliation(s)
- Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment/Institute for Healthcare Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
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