Cost-Effectiveness of Aclidinium Bromide versus Tiotropium Bromide for COPD

The results of a model-based health economic study showed that the use of aclidinium bromide as maintenance treatment of moderate-to-severe chronic obstructive pulmonary disease (COPD) may be more cost-effective than tiotropium bromide [Clinicoecon Outcomes Res. 2014;6:175-185].

The need to address the economic burden of COPD in the United States is highlighted by the annual costs of treating this disease, estimated by the National Heart, Lung and Blood Institute to account for $21.8 billion in direct costs alone.

To evaluate the cost-effectiveness of an alternative treatment for maintenance treatment for COPD, the study’s researchers used a cost-utility model to evaluate and compare the cost-effectiveness of aclidinium bromide (400 µg twice daily) and tiotropium bromide (18 µg once daily).

The patient population used reflected the characteristics of patients enrolled in clinical studies of aclidinium. These characteristics were >40 years of age, current smokers or former smokers with >10 pack-years, stable moderate-to-severe COPD, post-salbutamol forced expiratory volume in 1 second (FEV₁) ≥30%, and <80% of predicted normal value and FEV₁/forced vital capacity of <0.7.

Similar to the structure of a Markov cohort model, the model included 5 health states, of which 4 represented the severity of COPD (mild, moderate, severe, and very severe) and 1 represented death. The model calculated the proportion of patients in each health state according to the FEV₁.  The efficacy of treatment over 5 years was modeled using FEV₁/forced percent predicted, which was based on trough FEV₁.

Disease progression during the first 24 weeks was estimated based on a network meta-analysis that compared tiotropium and aclidinium. Estimation of long-term evolvement of trough FEV₁ after 24 weeks was based on long-term data from the UPLIFT (Understanding Potential Long-Term Impacts on Function With Triotropium) trial, a randomized, controlled trial comparing tiotropium to placebo over 4 years in patients with COPD.

Utility scores in US patients from the UPLIFT trial were used to assess quality of life. Cost-effectiveness was assessed as the incremental cost per quality-adjusted life year (QALY) gained.

The study found that both aclidinium and tiotropium accumulated 4.52 life years over 5 years. Aclidinium showed a marginal benefit in QUALYs compared with tiotropium (3.5 vs 3.49, respectively), with a mean difference of 0.0044 (95% confidence interval, -0.003-0.013]. Over 5 years, patients treated with aclidinium also had marginally fewer nonsevere exacerbations compared with tiotropium (3.364 vs 3.39, respectively) and severe exacerbations (0.565 vs 0.574, respectively).

In the study, use of aclidinium was associated with lower healthcare costs compared to tiotropium ($126,274 vs $128,591, respectively) due to lower drug costs over 5 years (mean, $11,162 vs $12,361, respectively) and lower cost of COPD management ($101,673 vs $102,642, respectively).

Aclidinium was associated with lower costs and marginally better QALYs compared with tiotropium in all scenario analyses performed. These scenarios included using discount factors of 0% and 6% for benefits and costs performed, scenarios on the cost of exacerbations, a scenario for a time horizon of 1 year, a scenario including the ACCORD II trial in the network meta-analysis, and a scenario using estimation of utilities by mapping St. George’s Respiratory Questionnaire to European Quality of Life-5 Dimensions. Analyses of costs in all of these scenarios showed a lower cost associated with aclidinium ($2458–-$444). Aclidinium was also associated with marginally greater QALYs (0.0041-0.0072).

These results indicate that aclidinium is potentially cost-effective compared to tiotropium as maintenance therapy for moderate-to-severe COPD. However, the authors noted limitations of the study and emphasized that the precision of the estimates are limited because long-term head-to-head trials between aclidinium and tiotropium are lacking.