Cost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countries

Research output: Contribution to journalArticle


Objective: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler (R) +tiotropium (TIO) HandiHaler (R) vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting beta(2)-agonists (ICS/LABA). 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 mu g bid + TIO 18 mu g qd or PBO bid + TIO 18 mu g 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 (sic), 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. Results: From a societal perspective, the ICER was estimated at (sic)174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 ((sic)212), (sic)307 and SEK 1573 ((sic) 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. Conclusion: BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries. ( Identifier: NCT00496470). (C)2013 Elsevier Ltd. All rights reserved.


  • Rune Nielsen
  • Hannu Kankaanranta
  • Leif Bjermer
  • Peter Lange
  • Sofie Arnetorp
  • Morten Hedegaard
  • Anna Stenling
  • Nicole Mittmann
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Respiratory Medicine and Allergy


  • Budesonide/formoterol, Tiotropium, Cost effectiveness, Nordic, COPD
Original languageEnglish
Pages (from-to)1709-1721
JournalRespiratory Medicine
Issue number11
Publication statusPublished - 2013
Publication categoryResearch