Cost-effectiveness of tiotropium versus salmeterol: the POET-COPD trial

The aim of this study was to perform a 1-year trial-based cost-effectiveness analysis (CEA) of tiotropium versus salmeterol followed by a 5-year model-based CEA. The within-trial CEA, including 7250 patients with moderate-to-very severe COPD, was performed alongside the 1-year international, randomized controlled POET-COPD trial comparing tiotropium with salmeterol regarding the effect on exacerbations. Main endpoints of the trial-based analysis were costs, number of exacerbations and exacerbation days. The model-based analysis was conducted to extrapolate results to 5 years and to calculate quality-adjusted life years (QALYs). One-year costs per patient from the German Statutory Health Insurance (SHI) perspective and the societal perspective were €126 (95% uncertainty interval (UI):55-195) and €170 (95% UI: 77-260) higher for tiotropium, respectively. The annual number of exacerbations was 0.064 (95% UI: 0.010-0.118) lower for tiotropium, leading to a reduction in exacerbationrelated costs of €87 (95% UI: 19-157). The incremental cost-effectiveness ratio (ICER) was €1961 per exacerbation avoided from the SHI perspective and €2647 from the societal perspective. In the model-based analyses, the 5-year costs per QALY for the two perspectives were €3488 and €8141, respectively. Tiotropium reduced exacerbations and exacerbation-related costs, but increased total costs. The resulting cost-effectiveness ratios were below commonly accepted willingness-to-pay thresholds.

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