Indacaterol/glycopyrronium is cost-effective compared to salmeterol/fluticasone in COPD: FLAME-based modelling in a Swedish population

Leif Bjermer,Nicolas Roche,Petter Olsson,Karin Lisspers,Job F M Van Boven,Dorothy L Keininger,Ronan Mahon,Madlaina Costa-Scharplatz,Florian S Gutzwiller

doi:10.1186/s12931-017-0688-5

Abstract

BackgroundThis study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year.MethodsA previously published and validated patient-level simulation model was adapted using clinical data from the FLAME trial and real-world cost data from the ARCTIC study. Costs (total monetary costs comprising drug, maintenance, exacerbation, and pneumonia costs) and health outcomes (life-years (LYs), quality-adjusted life-years (QALYs)) were projected over various time horizons (1, 5, 10 years, and lifetime) from the Swedish payer’s perspective and were discounted at 3% annually. Uncertainty in model input values was studied through one-way and probabilistic sensitivity analyses. Subgroup analyses were also performed.ResultsIND/GLY was associated with lower costs and better outcomes compared with SFC over all the analysed time horizons. Use of IND/GLY resulted in additional 0.192 LYs and 0.134 QALYs with cost savings of €1211 compared with SFC over lifetime. The net monetary benefit (NMB) was estimated to be €8560 based on a willingness-to-pay threshold of €55,000/QALY. The NMB was higher in the following subgroups: severe (GOLD 3), high risk and more symptoms (GOLD D), females, and current smokers.ConclusionIND/GLY is a cost-effective treatment compared with SFC in COPD patients with mMRC dyspnea grade ≥ 2, moderate to very severe airflow limitation, and ≥1 exacerbation in the preceding year.

Highlights

This study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/ fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year
Two previously conducted cost-effectiveness analyses (CEAs) have shown favourable cost-effectiveness of IND/GLY compared with SFC in patients with moderate-to-severe COPD and a history of one or no exacerbation in the previous year [12, 13]
Study design A previously published and validated microsimulation model [14], was employed to assess the cost-effectiveness of IND/ GLY compared with SFC, and was adapted for the present analysis by incorporating clinical data from the FLAME study and real-world Swedish cost data

Summary

Introduction

This study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/ fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year. The use of inhaled corticosteroid (ICS)-containing combination therapies, such as salmeterol/fluticasone (SFC) may only be a first choice therapy in COPD patients with features of asthma [1]. Key evidence for this recent GOLD strategy comes from the FLAME trial which demonstrated the superiority of IND/GLY in significantly reducing the rate of moderate or severe COPD exacerbations by 17% vs salmeterol/fluticasone (SFC) and increasing time-tofirst moderate or severe exacerbation in patients with dyspnoea modified Medical Research Council (mMRC) scale grade ≥ 2 and a documented history of ≥1 moderate or severe COPD exacerbations during the previous year [8]. This, along with the results demonstrated in the ILLUMINATE and LANTERN trial, indicates that IND/GLY addresses needs for both exacerbating and non-exacerbating patients, with a lower risk of pneumonia (the clinical significance of reduced incidence of pneumonia remains to be elucidated) than ICScontaining regimens [9, 10]

Methods

Results

Discussion

Conclusion