Cost effectiveness of tiotropium in patients with asthma poorly controlled on inhaled glucocorticosteroids and long-acting β-agonists

Appl Health Econ Health Policy. 2014 Aug;12(4):447-59. doi: 10.1007/s40258-014-0107-8.


Background: A considerable proportion of patients with asthma remain uncontrolled or symptomatic despite treatment with a high dose of inhaled glucocorticosteroids (ICSs) and long-acting β2-agonists (LABAs). Tiotropium Respimat(®) added to usual care improves lung function, asthma control, and the frequency of non-severe and severe exacerbations, in a population of adult asthma patients who are uncontrolled despite treatment with ICS/LABA.

Objective: This study estimated the cost effectiveness of tiotropium therapy as add-on to usual care in asthma patients that are uncontrolled despite treatment with ICS/LABA combination from the perspective of the UK National Health Service (NHS).

Methods: A Markov model was developed which considers levels of asthma control and exacerbations. The model analysed cost and quality-adjusted life-years (QALYs); sensitivity and scenario analyses were also conducted to test the robustness of the base case outcomes. All costs are given at 2012 prices.

Results: The model found that in this category of asthma with unmet need, add-on tiotropium therapy generated an incremental 0.24 QALYs and £5,238 costs over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of £21,906 per QALY gained. Sensitivity analysis suggested that findings were most dependent on the costs of managing uncontrolled asthma and the cost of treatment with tiotropium.

Conclusion: In this modelled analysis of two clinical trials, tiotropium was found to be cost effective when added to usual care in patients who remain uncontrolled despite treatment with high-dose ICS/LABA. Further research should investigate the long-term treatment effectiveness of tiotropium.

MeSH terms

  • Adrenergic beta-Agonists / administration & dosage*
  • Asthma / drug therapy*
  • Asthma / economics
  • Bronchodilator Agents / economics*
  • Bronchodilator Agents / therapeutic use
  • Cost-Benefit Analysis*
  • Delayed-Action Preparations / administration & dosage
  • Humans
  • Markov Chains
  • Quality-Adjusted Life Years
  • Respiratory Therapy
  • Scopolamine Derivatives / economics*
  • Scopolamine Derivatives / therapeutic use
  • Tiotropium Bromide
  • Treatment Outcome


  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Delayed-Action Preparations
  • Scopolamine Derivatives
  • Tiotropium Bromide