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Original Article

J App Pharm Sci. 2021; 11(9): 129-138

Meta-analysis of cost-effectiveness of three-drug therapy versus two-drug therapy in chronic obstructive pulmonary disease patients

Aamir Ali Syed, Ganesh Narayan Sharma, Birendra Shrivastav, Aleemuddin Naveed Mohd.


Healthcare expenditures on chronic obstructive pulmonary disease (COPD) have increased substantially globally. Thus, there is a need to find a cost-effective approach for the treatment of COPD. This meta-analysis aimed to evaluate the cost-effectiveness of triple therapy [long acting beta2 agonists (LABA)/long-acting muscarinic antagonist (LAMA)/inhaled corticosteroids (ICS)] versus dual therapy (LABA/LAMA and LABA/ICS) in moderate to severe COPD patients. Studies evaluating the cost-effectiveness of triple therapy versus dual therapy were identified through PubMed and Scopus from 2011 (January) to 2021(January) and meta-analyzed using a random-effects model. Results were presented as standardized mean differences (SMD) of quality-adjusted life years (QALY), life years (LY) gained, Costs, incremental cost-effectiveness ratios (ICER), incremental net monetary benefits (INMB), and incremental net health benefits (INHB). Of the 125 studies identified, four model analyses were included and meta-analyzed. QALY [SMD: 0.22; 95% confidence interval (CI): 0.16, 0.28], LY gained (SMD: 0.14; 95% CI: 0.10, 0.19), ICER (SMD: 0.96; 95% CI: 0.55, 1.38), INMB (SMD: 0.14; 95% CI: 0.12, 0.16), and INHB (SMD: 0.17; 95% CI: 0.13, 0.21) favored triple therapy. The results indicate that triple therapy is cost-effective than dual therapy in moderate to severe COPD patients as it provides more QALY and LY but at an additional cost.

Key words: Meta-analysis, chronic obstructive pulmonary disease, Quality adjusted life years, Incremental cost-effectiveness ratio, net monetary benefit, net health benefit.

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