ABSTRACT
OBJECTIVES: The objective of this study was to assess the potential for cost-effectiveness of new technologies for chronic obstructive pulmonary disease (COPD) over the period from 2001 to 2010. METHODS: Lung function outcomes and drug prices were observed for a UK COPD population over the period from 2001 to 2010. Cost-effectiveness was assessed at regular intervals on the basis of an established cost-effectiveness model, and the maximum price a technology providing cure could achieve under the current cost-effectiveness rules was estimated. RESULTS: The results of this study show that although the scope for clinical improvement in COPD was still considerable, during the 10 years studied, the potential for cost-effectiveness at each point in time was dependent on momentary market characteristics, such as the changing price of comparators and improvements in clinical effectiveness. As a result, the analysis demonstrates that the future cost-effectiveness of a technology in development depends on the manner pricing and clinical effectiveness evolve throughout time. CONCLUSIONS: Because any predictions will be short-lived and dependent on a number of uncertain factors, we conclude that producing accurate forecasts on the potential for cost-effectiveness of new therapies earlier during the development process is especially difficult under the current static cost-effectiveness framework.
Subject(s)
Health Policy/economics , Pulmonary Disease, Chronic Obstructive/economics , Pulmonary Disease, Chronic Obstructive/therapy , Technology Assessment, Biomedical/economics , Adrenal Cortex Hormones/economics , Adrenal Cortex Hormones/therapeutic use , Aged , Body Height , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/classification , Bronchodilator Agents/economics , Bronchodilator Agents/therapeutic use , Cohort Studies , Cost-Benefit Analysis , Disease Progression , Female , Forced Expiratory Volume/drug effects , Forced Expiratory Volume/physiology , Humans , Male , Nebulizers and Vaporizers/economics , Pulmonary Disease, Chronic Obstructive/physiopathology , Quality-Adjusted Life Years , United KingdomABSTRACT
OBJECTIVES: The purpose of this study was to develop and validate an algorithm that predicts EQ-5D utility from the St. George's Respiratory Questionnaire (SGRQ) in subjects with chronic obstructive pulmonary disease and to examine the effect of using this algorithm in predicting quality-adjusted life-years (QALYs). METHODS: In the TORCH (Towards a Revolution in COPD Health) trial, the SGRQ and EQ-5D were administered at baseline and every 24 weeks for 3 years. To map EQ-5D utility from the SGRQ, ordinary least squares (OLS), generalized linear models (GLMs) and two-part models were used. Algorithms were developed in a fitting sample and used to predict utility scores in a validation sample and selected based on root-mean-square error (RMSE). QALYs were estimated from the algorithm and compared to QALYs derived from EQ-5D utility scores collected in the trial. RESULTS: A simple OLS algorithm was found to perform as well as algorithms developed using more complex modeling structures. The resulting model was (RMSE 0.1723): EQ-5D = 0.9617 - 0.0013 × SGRQ total - 0.0001 × SGRQ total(2) + 0.0231 × male. Ordering of treatments by QALY gain was dependent on the method of utility estimation. CONCLUSION: A mapping algorithm can be used to predict EQ-5D utility scores from the SGRQ and may be useful in some situations; however, for use in a health technology assessment (HTA) submission in which precision of estimation is important, it is in the interests of both the manufacturer and the HTA body that utility scores be directly derived from the clinical trial population.
Subject(s)
Algorithms , Pulmonary Disease, Chronic Obstructive/physiopathology , Quality-Adjusted Life Years , Severity of Illness Index , Sickness Impact Profile , Aged , Clinical Trials as Topic , Female , Health Status Indicators , Humans , Logistic Models , Male , Middle Aged , Reproducibility of ResultsABSTRACT
COPD exerts a substantial burden on health and health care systems globally and will continue to do so for the foreseeable future. Treatment however can be costly and health care providers are interested in both whether treatments can offer improvements in disease burden and whether they represent value for money. Economic evaluations seek to resolve this issue by producing results that can be used to inform and assist the decision maker in allocating scarce health care resources. In this paper we introduce economic evaluation and then use these themes to review and critically appraise the existing COPD economic evaluations, in order to assess quality in light of today's standards. The use of existing economic evaluations in informing the decision maker is then discussed. Ten out of the fifteen studies were clinical trial or observational study based, and the remaining five on a decision analytic model. Study design, interventions, outcome measures and the use of uncertainty varied considerably; consequentially the results are difficult to compare in any consistent manner. Efforts for future studies to harmonize study design and methodology, particularly towards adopting a modeling framework, using current treatment as comparator and adopting a common effectiveness measure, such as the QALY, should be made in order to produce results that are comparable and useful to a decision maker.
