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The objective of this economic analysis was to determine the cost effectiveness and the budgetary impact, in a Canadian context, of CT versus LABA alone. Using the clinical guidelines and present management of COPD as the basis for our analysis, we examined the following interventions: : maintenance therapy for all patients with COPD using LABA alone : CT for severe cases (FEV1 <35% predicted) only, and LABA for the remainder of patients with moderate or mild disease : CT for severe or moderate COPD cases (FEV1 <50% predicted), and LABA for the remainder of COPD patients with mild disease : CT for all patients with COPD, regardless of severity.

Implications for Decision Making;

: CT in all COPD stages is more effective than LABA alone. Available evidence suggests that CT results in fewer overall exacerbations and improved quality of life measures, compared with treatment by LABA alone. There is no evidence to suggest that mortality differs with different strategies.

: Different treatment strategies will vary in cost-effectiveness. The lifetime cost of using a LABA (discounted at 5%) is 9,636 Canadian dollars per COPD patient. Adding an ICS for the most severe patients (strategy 2) results in an increase of 93 Canadian dollars per patient; strategy 3 increases costs by an additional 321 Canadian dollars; and strategy 4 increases costs by $3,120 Canadian dollars. Each strategy is associated with an additional increase of 0.01 quality-adjusted life year (QALY) per patient. Strategies 2 and 3 may be perceived as cost-effective by those who are prepared to pay up to 50,000 Canadian dollars for a QALY.

: CT requires additional resources. Switching all patients who are >65 years old and only receive a LABA without an ICS to CT treatment would require, by extrapolation, an additional 3.3 million Canadian dollars in Alberta, and 43.7 million Canadian dollars nationally.