Abstract
BackgroundThe IMPACT trial demonstrated superior outcomes following 52 weeks of once-daily single-inhaler treatment with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) (100/62.5/25 μg) compared with once-daily FF/VI (100/25 μg) or UMEC/VI (62.5/25 μg). This study evaluated the cost-effectiveness of FF/UMEC/VI compared with FF/VI or UMEC/VI for the treatment of chronic obstructive pulmonary disease (COPD) from a UK National Health Service perspective.MethodsPatient characteristics and treatment effects from IMPACT were populated into a hybrid decision tree/Markov economic model. Costs (GB£ inflated to 2018 equivalents) and health outcomes were modelled over a lifetime horizon, with a discount rate of 3.5% per annum applied to both. Sensitivity analyses were performed to test the robustness of key assumptions and input parameters.ResultsCompared with FF/VI and UMEC/VI, FF/UMEC/VI provided an additional 0.296 and 0.145 life years (LYs) (discounted) and 0.275 and 0.118 quality-adjusted life years (QALYs), at an additional cost of £1129 and £760, respectively. Incremental cost-effectiveness ratios (ICERs) for FF/UMEC/VI were £4104/QALY and £3809/LY gained versus FF/VI and £6418/QALY and £5225/LY gained versus UMEC/VI. At a willingness-to-pay threshold of £20 000/QALY, the probability that FF/UMEC/VI was cost-effective was 96% versus FF/VI and 74% versus UMEC/VI. Results were similar in a subgroup of patients recommended triple therapy in the 2019 National Institute for Health and Care Excellence COPD guideline.ConclusionsFF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a cost-effective option compared with FF/VI or UMEC/VI for patients with symptomatic COPD and a history of exacerbations in the UK at recognised cost-effectiveness threshold levels.
Highlights
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has noted that the healthcare costs associated with chronic obstructive pulmonary disease (COPD) are substantial and increase with disease severity [1]
In one-way sensitivity analyses, these results were shown to be most sensitive to the cost of both FF/UMEC/VI and UMEC/VI, and the utility associated with moderate COPD; Incremental cost-effectiveness ratios (ICERs) ranged from dominant to £12 888
In Probabilistic sensitivity analysis (PSA), FF/UMEC/VI was associated with improved health outcomes and was more costly than UMEC/VI in the majority of simulations with a probability of being cost-effective compared with UMEC/VI of 74% at a WTP threshold of £20 000 per quality-adjusted life years (QALYs) gained
Summary
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has noted that the healthcare costs associated with chronic obstructive pulmonary disease (COPD) are substantial and increase with disease severity [1]. The National Institute for Health and Care Excellence (NICE) 2019 Guideline on COPD recommended the use of triple therapy for patients receiving ICS/LABA if their dayto-day symptoms continue to adversely impact their quality of life, and for patients on either ICS/LABA or LAMA/LABA who experience a severe exacerbation requiring hospitalisation or two moderate exacerbations within a year [2]. Results were similar in a subgroup reflecting patients recommended triple therapy in the 2019 National Institute for Health and Care Excellence COPD guideline. Conclusions: FF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a cost-effective option compared with FF/VI or UMEC/VI for patients with symptomatic COPD and a history of exacerbations in the UK at recognised costeffectiveness threshold levels
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