Cost-Effectiveness Of Once-Daily Single-Inhaler Triple Therapy In COPD: The IMPACT Trial

Int J Chron Obstruct Pulmon Dis. 2019 Nov 29;14:2681-2695. doi: 10.2147/COPD.S216072. eCollection 2019.

Abstract

Background: We assessed the cost-effectiveness of single-inhaler fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) versus FF/VI or UMEC/VI from a Canadian public healthcare perspective, incorporating data from the IMPACT trial in chronic obstructive pulmonary disease (COPD) (NCT02164513).

Methods: Baseline inputs and treatment effects from IMPACT were populated into the validated GALAXY-COPD disease progression model. Canadian unit costs and drug costs (Canadian dollars [C$], 2017) were applied to healthcare resource utilization and treatments. Future costs and health outcomes were discounted at 1.5% annually. Analyses were probabilistic, and outputs included exacerbation rates, costs, and life years (LYs) and quality-adjusted life years (QALYs) gained.

Results: Compared with FF/VI and UMEC/VI over a lifetime horizon, the analyses predicted that treatment with FF/UMEC/VI resulted in fewer moderate and severe exacerbations, more LYs and more QALYs gained, with a small incremental cost. The base-case incremental cost-effectiveness ratio (ICER) per QALY gained was C$18,989 (95% confidence interval [CI]: C$14,665, C$25,753) versus FF/VI and C$13,776 (95% CI: C$9787, C$19,448) versus UMEC/VI. FF/UMEC/VI remained cost-effective versus both FF/VI and UMEC/VI in all sensitivity analyses, including in scenario analyses that considered different intervention and comparator discontinuation rates, and treatment effects for subsequent therapy.

Conclusion: Treatment with FF/UMEC/VI was predicted to improve outcomes and be a cost-effective treatment option for patients with symptomatic COPD and a history of exacerbations compared with FF/VI or UMEC/VI, in Canada.

Keywords: Canada; chronic obstructive pulmonary disease; cost-effectiveness; quality-adjusted life years; single-inhaler triple therapy.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Inhalation
  • Aged
  • Androstadienes / administration & dosage*
  • Androstadienes / adverse effects
  • Androstadienes / economics*
  • Benzyl Alcohols / administration & dosage*
  • Benzyl Alcohols / adverse effects
  • Benzyl Alcohols / economics*
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / adverse effects
  • Bronchodilator Agents / economics*
  • Canada
  • Chlorobenzenes / administration & dosage*
  • Chlorobenzenes / adverse effects
  • Chlorobenzenes / economics*
  • Clinical Trials, Phase III as Topic
  • Cost-Benefit Analysis
  • Disease Progression
  • Drug Combinations
  • Drug Costs*
  • Female
  • Humans
  • Lung / drug effects*
  • Lung / physiopathology
  • Male
  • Models, Economic
  • Nebulizers and Vaporizers
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / economics*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Quality of Life
  • Quality-Adjusted Life Years
  • Quinuclidines / administration & dosage*
  • Quinuclidines / adverse effects
  • Quinuclidines / economics*
  • Recovery of Function
  • Time Factors
  • Treatment Outcome

Substances

  • Androstadienes
  • Benzyl Alcohols
  • Bronchodilator Agents
  • Chlorobenzenes
  • Drug Combinations
  • GSK573719
  • Quinuclidines
  • vilanterol
  • fluticasone furoate

Associated data

  • ClinicalTrials.gov/NCT02164513