One-year cost-effectiveness of tiotropium versus ipratropium to treat chronic obstructive pulmonary disease

The aim of this paper is to assess the health economic consequences of substituting ipratropium with the new, once-daily bronchodilator tiotropium in patients with a diagnosis of chronic obstructive pulmonary disease (COPD). This prospective cost-effectiveness analysis was performed alongside two 1-yr randomised, double-blind clinical trials in the Netherlands and Belgium. Patients had a diagnosis of COPD and a forced expiratory volume in one second (FEV1) less than or equal to65% predicted normal. Patients were randomised to tiotropium (18 mug once daily) or ipratropium (2 puffs of 20 mug administered four times daily) in a ratio of 2:1. The mean number of exacerbations was reduced from 1.01 in the ipratropium group (n=175) to 0.74 in the tiotropium group (n=344). The percentages of patients with a relevant improvement on the St. George's Respiratory Questionnaire (SGRQ) were 34.6% and 51.2% respectively. Compared to ipratropium, the number of hospital admissions, hospital days and unscheduled visits to healthcare providers was reduced by 46%, 42% and 36% respectively. Mean annual healthcare costs including the acquisition cost of the study drugs were Euro1721 (SEM 160) in the tiotropium group and Euro1,541 (SEM 163) in the ipratropium group (difference Euro180). Incremental cost-effectiveness ratios were Euro667 per exacerbation avoided and Euro1084 per patient with a relevant improvement on the SGRQ. Substituting tiotropium for ipratropium in chronic obstructive pulmonary disease patients offers improved health outcomes and is associated with increased costs of Euro180 per patient per year.