Clinical Drug Investigation

, Volume 38, Issue 7, pp 611–620 | Cite as

Cost-Effectiveness of Fixed-Dose Combinations Therapies for Chronic Obstructive Pulmonary Disease Treatment

  • Margarita Capel
  • María Mareque
  • Carlos José Álvarez
  • Leandro Lindner
  • Itziar Oyagüez
Original Research Article


Background and Objective

Chronic obstructive pulmonary disease (COPD), a progressive lung disorder associated with decline of respiratory function, affects 10.2% of Spanish adults (40–80 years of age). This study aimed to assess the cost-effectiveness of two fixed-dose combinations of long-acting muscarinic antagonist and long-acting β2-agonist therapies for COPD, with Spanish National Health System perspective.


A Markov model with five health states based on severity levels defined by GOLD 2010 criteria was used to simulate in monthly cycles the evolution along a 5-year period of a cohort of moderate-to-severe COPD patients, treated with aclidinium–formoterol (ACL/FF) 400/12 µg or tiotropium–olodaterol (TIO/OLO) 5/5 µg fixed-dose combinations. Clinical data on lung-function improvement were obtained from a network meta-analysis and applied to mean baseline forced-expiratory-volume in 1 s (FEV1) for the first 24-weeks period. Natural history for lung-function decline (41 ml/year) was applied until the end of simulation. Risk of exacerbation and pneumonia occurrence were considered. Pharmaceutical costs were calculated with dosages according to indication and public ex-factory prices. The health state-specific disease management and event costs, and utilities were derived from the literature. Total costs (€ 2016) and benefits [life-year-gained (LYG) and quality-adjusted-life-year (QALY)] were discounted (3.0% yearly). Sensitivity analyses were performed.


Both therapies provided the same outcomes (4.073 LYG and 2.928 QALY) at 5-year period. ACL/FF 400/12 µg provided marginally lower costs (€ − 332) compared to TIO/OLO 5/5 µg.


ACL/FF 400/12 µg was a cost-saving therapy in patients with moderate-to-severe COPD in Spain, and provided equivalent effects compared to TIO/OLO 5/5 µg.


Compliance with Ethical Standards


This study was funded by AstraZeneca Spain.

Conflicts of interest

IO and MM are currently employed at PORIB, a consultant company specialized in economic evaluation of health interventions, which received financial support from AstraZeneca for the development of this study. CJA has received honoraria from Pharmacoeconomics and Outcomes Research Iberia for advocacy tasks related to this project. MC is an employee of AstraZeneca, Spain. LL is an employee of AstraZeneca, UK.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Astra ZenecaMadridSpain
  2. 2.Pharmacoeconomics and Outcomes Research Iberia (PORIB)MadridSpain
  3. 3.Servicio Neumología, Hospital 12 de OctubreMadridSpain
  4. 4.Astra ZenecaCambridgeUK

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