Cost effectiveness of tiotropium for chronic obstructive pulmonary disease: a systematic review of the evidence.
Cost effectiveness of tiotropium for chronic obstructive pulmonary disease: a systematic review of the evidence.
复制标题
DOI：
10.3111/13696998.2010.499813
复制
发表时间：
2010-01-01
影响因子：
2.4
通讯作者：
Juniper, Melissa D
中科院分区：
文献类型：
--
作者：
Mauskopf, Josephine A;Baker, Christine L;Juniper, Melissa D
背景技术背景：噻托溴铵已被证明可以减少慢性阻塞性肺疾病（COPD）患者的病情加重并改善其生活质量，COPD是一种以持续和进行性气流受限为特征的肺部疾病。结论：与目前使用的其他COPD治疗方法相比，噻托溴铵治疗的成本效益进行了系统的文献综述。通过PubMed、科克伦数据库和EMBASE进行了2002年至2009年的系统检索。方法和结果的研究设计和国家进行了比较。研究设计的特征如下：基于临床试验数据的建模，以及基于临床试验或观察数据的经验分析。比较单药治疗方案（12项研究），所有研究设计均发现噻托溴铵治疗与较低的住院和其他非药物服务费用相关。在部分（但不是全部）研究中，噻托溴铵的总成本（包括维持药物成本）较低。基于普遍接受的基准值，噻托溴铵显示出成本效益。该综述的局限性包括不同研究中使用的结果指标种类繁多，单药治疗的观察性数据库研究数量有限，联合治疗方案的数据有限。结论：从产品批准时的临床试验数据和后来反映临床使用的观察性数据中得出的经济评价的主要结论是相似的：使用噻托溴铵单药治疗与较低的住院费用和其他非药物费用以及较好的健康结果相关，并且与其他维持性单药治疗相比节省了费用或具有成本效益。
BACKGROUND: Tiotropium has been shown to reduce exacerbations and improve quality of life for patients with chronic obstructive pulmonary disease (COPD), a lung disease characterized by a persistent and progressive airflow limitation.OBJECTIVES: To present a systematic literature review of the cost effectiveness of treatment with tiotropium compared with other currently used treatments for COPD.METHODS: A systematic search was performed via PubMed, the Cochrane database, and EMBASE from 2002 to 2009. Methods and results by study design and by country were compared.RESULTS: Seventeen studies were included in the review. Study designs were characterized as follows: modeling based on clinical trial data, and empirical analysis based on either clinical trial or observational data. Comparing monotherapy regimens (12 studies), all study designs found that treatment with tiotropium was associated with lower costs for hospitalisation and other non-drug services. Total costs, including the costs of maintenance drugs, were lower with tiotropium in some, but not all, of the studies. Tiotropium was shown to be cost effective based on commonly accepted benchmark values. Limitations of the review included the wide variety of outcome measures used in different studies, the limited number of observational database studies for monotherapy, and limited data for combination therapy regimens.CONCLUSIONS: The main conclusions of the economic evaluations derived from clinical trial data at the time of product approval and from later observational data reflecting clinical use are similar: use of tiotropium monotherapy is associated with lower hospital and other non-drug costs and better health outcomes and is either cost saving or cost effective compared with other maintenance monotherapies.