Original Articles
Cost-Effectiveness Analysis of Tiotropium Compared to Ipratropium and Salmeterol
A.J. García Ruiza,
, F. Leiva Fernándezb, F. Martos Crespoa
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ajgr@uma.es
Correspondence: Prof. A.J. García Ruiz Unidad de Farmacoeconomía e IRS. Departamento de Farmacología. Facultad de Medicina. Campus deTeatinos UMA. 29071 Málaga. España
Correspondence: Prof. A.J. García Ruiz Unidad de Farmacoeconomía e IRS. Departamento de Farmacología. Facultad de Medicina. Campus deTeatinos UMA. 29071 Málaga. España
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Gómez-Caro Andrés, P. Ausín Herrero, F.J. Moradiellos Díez, V. Díaz-Hellín, E. Larrú Cabrero, J.A. Pérez Antón, J.L. Martín de Nicolás" "autores" => array:7 [ 0 => array:3 [ "preGrado" => "Dr." "nombre" => "A." "apellidos" => "Gómez-Caro Andrés" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Ausín Herrero" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "Moradiellos Díez" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Díaz-Hellín" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Larrú Cabrero" ] 5 => array:2 [ "nombre" => "J.A." "apellidos" => "Pérez Antón" ] 6 => array:2 [ "nombre" => "J.L." 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"apellidos" => "de Miguel Díez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906602164?idApp=UINPBA00003Z" "url" => "/15792129/0000004100000005/v1_201305150216/S1579212906602164/v1_201305150216/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>" "titulo" => "Cost-Effectiveness Analysis of Tiotropium Compared to Ipratropium and Salmeterol" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "242" "paginaFinal" => "248" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.J. García Ruiz, F. Leiva Fernández, F. Martos Crespo" "autores" => array:3 [ 0 => array:5 [ "preGrado" => "Prof." "nombre" => "A.J." "apellidos" => "García Ruiz" "email" => array:1 [ 0 => "ajgr@uma.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Leiva Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Martos Crespo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Farmacoeconomía e IRS, Departamento de Farmacología y Terapéutica Clínica, Universidad de Málaga, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Unidad Docente de Medicina de Familia y Comunitaria de Málaga, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Prof. A.J. García Ruiz Unidad de Farmacoeconomía e IRS. Departamento de Farmacología. Facultad de Medicina. Campus deTeatinos UMA. 29071 Málaga. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-06-18" "fechaAceptado" => "2004-10-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec154057" "palabras" => array:4 [ 0 => "Cost-effectiveness analysis" 1 => "Tiotropium" 2 => "Pharmacoeconomics" 3 => "Effectiveness" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154058" "palabras" => array:4 [ 0 => "Análisis coste-eficacia" 1 => "Tiotropio" 2 => "Farmacoeconomía" 3 => "Efectividad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The constant increase in health care costs, in a context of limited resources and the appearance of more costly though more effective drugs, justifies an assessment of the pharmacoeconomics of these drugs. The objective of this study was to evaluate the cost-effectiveness of one of the newest drugs for the treatment of chronic obstructive pulmonary disease (COPD)-tiotropium.</p> <span class="elsevierStyleSectionTitle">Material and method</span><p class="elsevierStyleSimplePara elsevierViewall">A cost-effectiveness analysis (costs and outcomes) within the framework of the Spanish National Health System was done. The alternatives to tiotropium analyzed were ipratropium and salmeterol Direct health care costs associated with hospital treatment were calculated. Forced expiratory volume in 1 second, quality of life (with the Saint George's Respiratory Questionnaire), dyspnea transitional index, mean stay in hospital, and exacerbations were the variables used to measure effectiveness. Values for these variables were taken from the main reviews and randomized clinical trials published for tiotropium.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">For COPD patients, treatment with tiotropium leads to a greater reduction in exacerbations (37% compared to ipratropium and 25% compared to salmeterol 25%), and a reduction in the number of days in hospital (33% compared to ipratropium and 14% compared to salmeterol). Therefore, use of tiotropium could save €100 000 for the current rates of admission and lengths of hospital stay in Spain.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Tiotropium was more effective than ipratropium and salmeterol as measured by objective clinical variables (forced expiratory volume in 1 second) and subjective ones (the Saint George's Respiratory Questionnaire and dyspnea transitional index). Hospital stays were shorter and exacerbations fewer with tiotropium. In all cases, tiotropium was more cost-effective than the alternatives, thus use of tiotropium could help hospitals to save money.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El incesante incremento de los costes en un marco en el que los recursos son limitados, así como la apa-rición de nuevos medicamentos más costosos y a la vez más eficaces, justifica la evaluación económica de los medicamentos. El objetivo de este trabajo es evaluar el coste-eficacia de uno de los fármacos más novedosos para el tratamien-to de la enfermedad pulmonar obstructiva crónica (EPOC), el tiotropio.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un análisis de coste-eficacia (costes y consecuencias) desde la perspectiva del Sistema Nacional de Salud. Las alternativas analizadas han sido ipratropio y salmeterol. Se han considerado sólo costes sanitarios directos en el ámbito hospitalario. Los paráme-tros de eficacia analizados han sido: volumen espiratorio forzado en el primer segundo, calidad de vida (mediante el Saint George's Respiratory Questionnaire), índice transicio-nal de disnea, estancias medias y exacerbaciones. Dichos pa-rámetros se han obtenido de las principales revisiones y en-sayos clínicos aleatorizados publicados sobre el tiotropio.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Teniendo en cuenta la reducción del número de exacerbaciones conseguida con el tiotropio frente al ipratropio y salmeterol (el 37 y el 25%, respectivamente) y del número de días de estancia hospitalaria (el 33 y el 14%, respectivamente), su utilización puede suponer un ahorro superior a los 100.000 € para las cifras actuales de tasa de ingresos y días de estancia hospitalaria de los pacientes con EPOC en España.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El tiotropio ha sido más efectivo que el ipratropio y salmeterol tanto en parámetros clínicos (objetivos, como el volumen espiratorio forzado en el primer segundo, y subjetivos, como el Saint George's Respiratory Questionnaire y el índice transicional de disnea) como en disminución de estancias hospitalarias y exacerbaciones. En todos los casos re-sulta más coste-efectivo que sus alternativas, lo que supone im-portantes ahorros en el ámbito hospitalario.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J Castillo Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "EPOC, perspectivas actuales" "fecha" => "1995" "editorial" => "Grupo Aula Médica de Formación Continuada" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de la enfermedad obstructiva crónica y del asma. 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| Year/Month | Html | Total | |
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| 2021 October | 15 | 38 | 53 |
| 2021 September | 16 | 47 | 63 |
| 2021 August | 12 | 30 | 42 |
| 2021 July | 12 | 25 | 37 |
| 2021 June | 12 | 32 | 44 |
| 2021 May | 9 | 31 | 40 |
| 2021 April | 31 | 57 | 88 |
| 2021 March | 16 | 15 | 31 |
| 2021 February | 12 | 13 | 25 |
| 2021 January | 8 | 18 | 26 |
| 2020 December | 12 | 21 | 33 |
| 2020 November | 7 | 11 | 18 |
| 2020 October | 4 | 7 | 11 |
| 2020 September | 7 | 10 | 17 |
| 2020 August | 10 | 18 | 28 |
| 2020 July | 10 | 16 | 26 |
| 2020 June | 9 | 2 | 11 |
| 2020 May | 20 | 16 | 36 |
| 2020 April | 12 | 13 | 25 |
| 2020 March | 16 | 15 | 31 |
| 2020 February | 18 | 19 | 37 |
| 2020 January | 17 | 20 | 37 |
| 2019 December | 12 | 19 | 31 |
| 2019 November | 10 | 18 | 28 |
| 2019 October | 4 | 12 | 16 |
| 2019 September | 7 | 20 | 27 |
| 2019 August | 9 | 15 | 24 |
| 2019 July | 5 | 20 | 25 |
| 2019 June | 6 | 5 | 11 |
| 2019 May | 7 | 19 | 26 |
| 2019 April | 11 | 47 | 58 |
| 2019 March | 11 | 38 | 49 |
| 2019 February | 12 | 14 | 26 |
| 2019 January | 5 | 12 | 17 |
| 2018 December | 9 | 20 | 29 |
| 2018 November | 8 | 25 | 33 |
| 2018 October | 12 | 16 | 28 |
| 2018 September | 10 | 12 | 22 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 3 | 10 | 13 |
| 2018 March | 3 | 2 | 5 |
| 2018 February | 5 | 7 | 12 |
| 2018 January | 11 | 12 | 23 |
| 2017 December | 6 | 7 | 13 |
| 2017 November | 3 | 9 | 12 |
| 2017 October | 4 | 8 | 12 |
| 2017 September | 4 | 7 | 11 |
| 2017 August | 8 | 17 | 25 |
| 2017 July | 1 | 2 | 3 |
| 2017 June | 6 | 12 | 18 |
| 2017 May | 7 | 14 | 21 |
| 2017 April | 1 | 2 | 3 |
| 2017 March | 2 | 5 | 7 |
| 2017 February | 2 | 5 | 7 |
| 2017 January | 2 | 8 | 10 |
| 2016 December | 8 | 15 | 23 |
| 2016 November | 5 | 6 | 11 |
| 2016 October | 10 | 17 | 27 |
| 2016 September | 5 | 7 | 12 |
| 2016 August | 7 | 4 | 11 |
| 2016 July | 36 | 44 | 80 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 52 | 1 | 53 |
| 2015 September | 45 | 11 | 56 |
| 2015 August | 28 | 11 | 39 |
| 2015 July | 46 | 13 | 59 |
| 2015 June | 40 | 6 | 46 |
| 2015 May | 55 | 13 | 68 |
| 2015 April | 47 | 14 | 61 |
| 2015 March | 42 | 8 | 50 |
| 2015 February | 52 | 6 | 58 |
| 2015 January | 53 | 11 | 64 |
| 2014 December | 59 | 13 | 72 |
| 2014 November | 43 | 11 | 54 |
| 2014 October | 64 | 14 | 78 |
| 2014 September | 51 | 15 | 66 |
| 2014 August | 44 | 14 | 58 |
| 2014 July | 41 | 9 | 50 |
| 2014 June | 59 | 9 | 68 |
| 2014 May | 66 | 16 | 82 |
| 2014 April | 68 | 10 | 78 |
| 2014 March | 66 | 23 | 89 |
| 2014 February | 64 | 16 | 80 |
| 2014 January | 57 | 14 | 71 |
| 2013 December | 45 | 10 | 55 |
| 2013 November | 44 | 17 | 61 |
| 2013 October | 51 | 72 | 123 |
| 2013 September | 29 | 10 | 39 |
| 2013 August | 40 | 10 | 50 |
| 2013 July | 48 | 10 | 58 |
| 2013 June | 28 | 11 | 39 |
| 2013 May | 38 | 12 | 50 |
| 2013 April | 30 | 9 | 39 |
| 2013 March | 8 | 2 | 10 |
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