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Cost-effectiveness of the LABA/LAMA dual bronchodilator indacaterol/glycopyrronium in a Swedish healthcare setting.

https://arctichealth.org/en/permalink/ahliterature264645
Source
Respir Med. 2014 Dec;108(12):1786-93
Publication Type
Article
Date
Dec-2014
Author
David Price
Dorothy Keininger
Madlaina Costa-Scharplatz
Karen Mezzi
Maria Dimova
Yumi Asukai
Björn Ställberg
Source
Respir Med. 2014 Dec;108(12):1786-93
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Aged
Albuterol - analogs & derivatives - economics - therapeutic use
Androstadienes - economics - therapeutic use
Bronchodilator Agents - administration & dosage - economics - therapeutic use
Cost-Benefit Analysis
Double-Blind Method
Drug Combinations
Drug Costs - statistics & numerical data
Drug Therapy, Combination
Female
Forced Expiratory Volume - drug effects
Glycopyrrolate - administration & dosage - economics - therapeutic use
Humans
Indans - administration & dosage - economics - therapeutic use
Male
Middle Aged
Monte Carlo Method
Pulmonary Disease, Chronic Obstructive - drug therapy - economics - physiopathology
Quinolones - administration & dosage - economics - therapeutic use
Sweden
Abstract
Indacaterol/glycopyrronium (IND/GLY) is a once-daily inhaled fixed-dose combination of indacaterol (IND), a long-acting ß2-adrenergic agonist (LABA), and glycopyrronium (GLY), a long-acting muscarinic antagonist (LAMA) for use as maintenance treatment to relieve symptoms of chronic obstructive pulmonary disease (COPD) in adults.
To determine the economic benefits of IND/GLY compared with the free combination of indacaterol and glycopyrronium (IND + GLY), and with the fixed-dose combination of salmeterol/fluticasone (SFC), in a moderate-to-severe COPD population with low-exacerbation risk. The model-based analysis extrapolated results up to lifetime time horizon and calculated costs per quality-adjusted life year.
Assuming equal efficacy, a cost-minimisation analysis compared IND/GLY vs IND + GLY using model inputs from the double-blind, randomised SHINE trial. The double-blind, randomised ILLUMINATE and TORCH trials were used to analyse cost-effectiveness versus SFC. To consider ICS-related pneumonia events, published odds ratio comparing an ICS-exposed group to a control group of COPD patients was used. Direct and indirect drug costs as well as drug acquisition costs (in Swedish Krona [SEK]) were derived from published Swedish sources. Cost and effects were discounted with 3%. Uncertainty was assessed by one-way and probabilistic sensitivity analyses (PSA).
IND/GLY was cost-saving vs IND + GLY with incremental savings of SEK (EUR) 768 (85), and 3309 (368) per patient over one and five years. IND/GLY was found to be less costly and more effective compared to SFC with cost savings of SEK (EUR) 2744 (303), 8854 (976), 13,938 (1536), 27,495 (3031) and 43,033 (4744) over one, three, five, ten years and lifetime. The PSA indicated that all iterations produced dominant results for IND/GLY.
IND/GLY is cost-minimising vs IND + GLY and dominates SFC in the maintenance treatment of COPD patients in Sweden. Encouraging dual bronchodilator therapy over an ICS-containing combination results in lower total costs and better outcomes compared to combination therapy including fluticasone in moderate-to-severe COPD patients with low exacerbation risk.
PubMed ID
25307414 View in PubMed
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Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature307773
Source
NPJ Prim Care Respir Med. 2019 12 10; 29(1):45
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
12-10-2019
Author
Karin Lisspers
Kjell Larsson
Christer Janson
Björn Ställberg
Ioanna Tsiligianni
Florian S Gutzwiller
Karen Mezzi
Bine Kjoeller Bjerregaard
Leif Jorgensen
Gunnar Johansson
Author Affiliation
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden. karin.lisspers@ltdalarna.se.
Source
NPJ Prim Care Respir Med. 2019 12 10; 29(1):45
Date
12-10-2019
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Drug Administration Routes
Female
Follow-Up Studies
Forecasting
Glucocorticoids - administration & dosage
Humans
Incidence
Male
Middle Aged
Prognosis
Pulmonary Disease, Chronic Obstructive - drug therapy - epidemiology
Retrospective Studies
Sex Distribution
Sex Factors
Survival Rate - trends
Sweden - epidemiology
Abstract
The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000-2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.
PubMed ID
31822681 View in PubMed
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The Impact of Exacerbation Frequency on Clinical and Economic Outcomes in Swedish COPD Patients: The ARCTIC Study.

https://arctichealth.org/en/permalink/ahliterature311239
Source
Int J Chron Obstruct Pulmon Dis. 2021; 16:701-713
Publication Type
Journal Article
Date
2021
Author
Kjell Larsson
Christer Janson
Karin Lisspers
Björn Ställberg
Gunnar Johansson
Florian S Gutzwiller
Karen Mezzi
Bine Kjoeller Bjerregaard
Leif Jorgensen
Author Affiliation
Integrative Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
Source
Int J Chron Obstruct Pulmon Dis. 2021; 16:701-713
Date
2021
Language
English
Publication Type
Journal Article
Abstract
The aim of this study was to assess the association between exacerbation frequency and clinical and economic outcomes in patients with COPD.
Electronic medical record data linked to National Health Registries were collected from COPD patients at 52 Swedish primary care centers (2000-2014). The outcomes analyzed were exacerbation rate, mortality, COPD treatments, lung function and healthcare costs during the follow-up period. Based on the exacerbation rate two years before index date, the patients were initially classified into three groups, either 0, 1 or =2 exacerbations per year. After the index date, the classification into exacerbation groups was updated each year based on the exacerbation rate during the last year of follow-up. A sensitivity analysis was conducted excluding patients with asthma diagnosis from the analysis.
In total 18,586 COPD patients were analyzed. A majority of the patients (60-70%) who either have had no exacerbation or frequent exacerbations (=2/year) during the pre-index period remained in their group (ie, with 0 or =2 annual exacerbations) during up to 11 years of follow-up. Compared with having no exacerbation, mortality was higher in patients having 1 (HR; 2.06 [1.93-2.20]) and =2 (4.58 [4.33-4.84]) exacerbations at any time during the follow-up. Lung function decline was more rapid in patients with frequent exacerbations and there was an almost linear relationship between exacerbations frequency and mortality. Total healthcare costs were higher in the frequent exacerbation group (=2/year) than in patients with no or one exacerbation annually (p
PubMed ID
33776429 View in PubMed
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Osteoporosis and fracture risk associated with inhaled corticosteroid use among Swedish COPD patients: the ARCTIC study.

https://arctichealth.org/en/permalink/ahliterature304587
Source
Eur Respir J. 2021 Feb; 57(2):
Publication Type
Journal Article
Date
Feb-2021
Author
Christer Janson
Karin Lisspers
Björn Ställberg
Gunnar Johansson
Florian S Gutzwiller
Karen Mezzi
Linda Mindeholm
Bine Kjoeller Bjerregaard
Leif Jorgensen
Kjell Larsson
Author Affiliation
Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden christer.janson@medsci.uu.se.
Source
Eur Respir J. 2021 Feb; 57(2):
Date
Feb-2021
Language
English
Publication Type
Journal Article
Abstract
The effect of inhaled corticosteroids (ICS) on the risk of osteoporosis and fracture in patients with chronic obstructive pulmonary disease (COPD) remains uncertain. The aim of this study was to assess this risk in patients with COPD.Electronic medical record data linked to National Health Registries were collected from COPD patients and matched reference controls at 52 Swedish primary care centres from 2000 to 2014. The outcomes analysed were the effect of ICS on all fractures, fractures typically related to osteoporosis, recorded osteoporosis diagnosis, prescriptions of drugs for osteoporosis and a combined measure of any osteoporosis-related event. The COPD patients were stratified by the level of ICS exposure.A total of 9651 patients with COPD and 59?454 matched reference controls were analysed. During the follow-up, 19.9% of COPD patients had at least one osteoporosis-related event compared with 12.9% of reference controls (p
PubMed ID
32972982 View in PubMed
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