Comparative cost-effectiveness analysis of theophylline and ipratropium bromide in chronic obstructive pulmonary disease. A three-center study

Chest. 1993 Mar;103(3):678-84. doi: 10.1378/chest.103.3.678.


The charts of 311 patients receiving theophylline (T) and 289 patients receiving ipratropium bromide (IB) for COPD were reviewed to determine the total costs and cost-effectiveness of these 2 agents in 3 different health-care settings. A direct cost-accounting method assessed cost, and a Markov decision-analysis model calculated cost-effectiveness. Costs to treat toxic effects were greater for T versus IB. The types and incidences of toxic effects, by drug, were similar among the three centers. Overall costs for T were $121.40 per patient per therapy-month versus $84.56 per patient per therapy-month for IB, as determined by the cost-accounting method. The marginal cost was $366 for T over IB when extrapolated over 1 year using the Markov model. The Markov model also predicted that patients receiving IB had a greater number of complication-free therapy-months (measurement of effectiveness) than patients receiving T. We conclude that treatment with IB was less costly and more cost-effective than T.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Analysis of Variance
  • California
  • Chi-Square Distribution
  • Cost of Illness*
  • Cost-Benefit Analysis / statistics & numerical data*
  • Female
  • Health Maintenance Organizations / economics
  • Health Maintenance Organizations / statistics & numerical data
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Hospitals, University / economics
  • Hospitals, University / statistics & numerical data
  • Hospitals, Veterans / economics
  • Hospitals, Veterans / statistics & numerical data
  • Humans
  • Illinois
  • Ipratropium / adverse effects
  • Ipratropium / economics*
  • Lung Diseases, Obstructive / drug therapy*
  • Lung Diseases, Obstructive / economics*
  • Lung Diseases, Obstructive / epidemiology
  • Male
  • Markov Chains
  • Middle Aged
  • Sensitivity and Specificity
  • Theophylline / adverse effects
  • Theophylline / economics*
  • Treatment Outcome


  • Theophylline
  • Ipratropium