Costs of Tiotropium Bromide Delivered via the Respimat® Inhaler in COPD Patients in Italy

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality worldwide. The clinical trial by Bateman and colleagues, that enrolled 3,991 moderate to very severe COPD patients in 31 Countries, demonstrated that tiotropium bromide delivered via the Respimat® inhaler can delay the time to first exacerbation and reduce overall exacerbation rates. The aim of our study was to estimate the costs associated with this device utilization to treat COPD in Italy. The analysis was conducted from the perspective of the Italian National Health Service (INHS) with a time horizon of one year. Tiotropium delivered with the Respimat® inhaler on top of the standard of care (SoC) was compared with SoC alone. Effectiveness was measured in terms of relative risk of exacerbations, derived from the Bateman trial. The average costs for routine COPD treatment and for the management of exacerbations were based on the economic literature. The total cost per patient/year was €3,469 (routine cost €670; exacerbation cost €2,799) with SoC and €3,369 (routine cost €840; exacerbation cost €2,529) with tiotropium in add-on to the SoC. The total saving per patient/year was about €100, corresponding to 2.9% of the total annual cost. Taking into account the total population with moderate to very severe COPD in Italy (1,880,500 patients, according to the available epidemiological data), this treatment strategy would result in a total saving of about €188 million per year. In conclusion, this study showed that adoption of tiotropium bromide delivered via the Respimat® inhaler has the potential to reduce the economic burden of COPD in Italy.