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dc.contributor.authorNielsen, Runeeng
dc.contributor.authorKankaanranta, Hannueng
dc.contributor.authorBjermer, Leifeng
dc.contributor.authorLange, Petereng
dc.contributor.authorArnetorp, Sofieeng
dc.contributor.authorHedegaard, Morteneng
dc.contributor.authorStenling, Annaeng
dc.contributor.authorMittmann, Nicoleeng
dc.date.accessioned2015-04-10T10:49:35Z
dc.date.available2015-04-10T10:49:35Z
dc.date.issued2013-11eng
dc.identifier.issn0954-6111eng
dc.identifier.urihttp://hdl.handle.net/1956/9750
dc.description.abstract<p>Objective: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler®+tiotropium (TIO) HandiHaler® vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA).<p> <p>Methods: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial. The study included 659 patients with pre-bronchodilator forced expiratory volume in 1 s ≤ 50% and ≥1 exacerbation requiring systemic glucocorticosteroids or antibiotics the preceding year. Patients received BUD/FORM 320/9 μg bid + TIO 18 μg qd or PBO bid + TIO 18 μg qd. Effectiveness was defined as the number of severe exacerbations (hospitalisation/emergency room visit/systemic glucocorticosteroids) avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from CLIMB was combined with Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs (2010). The incremental cost-effectiveness ratios (ICERs) for BUD/FORM + TIO vs. PBO + TIO were estimated using descriptive statistics and uncertainty around estimates using bootstrapping. Analyses were conducted from the societal and healthcare perspectives in Denmark, Finland, Norway and Sweden.</p> <p>Results: From a societal perspective, the ICER was estimated at €174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 (€212), €307 and SEK 1573 (€165) per severe exacerbation avoided for Denmark, Finland and Sweden, respectively, while BUD/FORM + TIO was dominant in Norway. Including antibiotics decreased ICERs by 8–15%. Sensitivity analyses showed that results were overall robust.</p> <p>Conclusion: BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries.</p>en_US
dc.language.isoengeng
dc.publisherElseviereng
dc.rightsAttribution-NonCommercial-NoDerivs CC BY-NC-NDeng
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/eng
dc.subjectBudesonide/formoteroleng
dc.subjectTiotropiumeng
dc.subjectCost-effectivenesseng
dc.subjectNordiceng
dc.subjectCOPDeng
dc.titleCost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countrieseng
dc.typeJournal articleeng
dc.subject.nsiVDP::Medisinske fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710::Klinisk farmakologi: 739nob
dc.subject.nsiVDP::Medisinske fag: 700::Klinisk medisinske fag: 750::Lungesykdommer: 777nob
dc.subject.nsiVDP::Medical sciences: 700::Basic medical, dental and veterinary sciences: 710::Clinical pharmacology: 739eng
dc.subject.nsiVDP::Medical sciences: 700::Clinical medical sciences: 750::Lung diseases: 777eng
dc.date.updated2015-04-01T08:25:46Zen_US
dc.rights.holderCopyright 2013 Elsevier Ltd.
dc.type.versionpublishedVersioneng
bora.peerreviewedPeer reviewedeng
bora.journalTitleRespiratory Medicineeng
bibo.volume107eng
bibo.issue11eng
bibo.pageStart1709eng
bibo.pageEnd1721eng
bibo.doihttp://dx.doi.org/10.1016/j.rmed.2013.06.007eng
bora.accessRightsinfo:eu-repo/semantics/openAccesseng
dc.identifier.cristinID1094788eng
dc.identifier.doi10.1016/j.rmed.2013.06.007


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