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

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.

Conflict of interest statement

The authors declare the following conflicts of interest during the last three years in relation to this article: A.S. Ismaila, M. Schroeder and A. Martin are employees of, and hold shares in, GlaxoSmithKline plc.; A.S. Ismaila is also an unpaid, part-time professor at McMaster University, Canada. E.C. Goodall is an employee of GlaxoSmithKline plc. N. Risebrough, D. Shah and K. Ndirangu are employees of ICON plc., which received funding from GlaxoSmithKline plc. to conduct this study, but were not themselves paid for development of this article. G. Criner reports grants and personal fees from GlaxoSmithKline plc., Boehringer Ingelheim, Chiesi, Mereo, AstraZeneca, Pulmonx, PneumRx, Olympus, Broncus, Lungpacer, Mereo, Nuvaira, ResMed, Respironics and Patara, Pearl, and Sanofi, personal fees from Verona, BTG, EOLO and NGM, and grants from ALung, Fisher Paykel and Galapagos, outside the submitted work. M. Dransfield reports personal and other fees from GlaxoSmithKline plc. during the conduct of this study, and grants from Department of Defense, personal and other fees from Boehringer Ingelheim, GlaxoSmithKline plc., AstraZeneca and PneumRx/BTG, personal fees from Genentech, Quark Pharmaceuticals and Mereo, grants from NIH and American Lung Association and other fees from Novartis, Yungjin, Pulmonx and Boston Scientific, outside the submitted work. D.M.G. Halpin reports personal fees from AstraZeneca, Chiesi, GlaxoSmithKline plc. and Pfizer, and personal fees and non-financial support from Boehringer Ingelheim and Novartis, outside the submitted work. M.L. Han reports personal fees from GlaxoSmithKline plc. during the conduct of this study, and personal fees from GlaxoSmithKline plc., Boehringer Ingelheim, AstraZeneca, Mylan, and other fees from Novartis and Sunovion, outside of the submitted work. D.A. Lomas reports grants, personal fees and non-financial support from GlaxoSmithKline plc. during the conduct of the study, and personal fees and grants from GlaxoSmithKline plc., and personal fees from Griffols, outside of the submitted work. D.A. Lomas also chaired the Respiratory Therapy Area Board at GlaxoSmithKline plc. between 2012 and 2015. The authors report no other conflicts of interest in this work.

© 2019 Ismaila et al.

Figures

Figure 1

Linked-risk equation model. Blue lines indicate the relationship between the central attributes in the different time periods. Orange lines indicate the relationship between intermediate outcomes and exacerbations. Black lines indicate the relationship between the central attributes and the final health outcomes. Adapted from Briggs AH, Baker T, Risebrough NA, et al (2017). Development of the Galaxy Chronic Obstructive Pulmonary Disease (COPD) Model Using Data from ECLIPSE: Internal Validation of a Linked-Equations Cohort Model Med Decis Making, 37(4): 469–480. https://doi.org/10.1177/0272989X16653118. Copyright © 2017 by the authors. Reprinted by permission of SAGE Publications, Inc. *Calculated (in mL) using the risk equation at 1 year and converted to FEV1% predicted based on the cohort profile. Abbreviations: 6MWT, 6-min walk test; FEV1, forced expiratory volume in 1 s; LY, life year; QALY, quality-adjusted life year; RU, resource utilization; SGRQ, St. George’s Respiratory Questionnaire.

Figure 2

Incremental cost-effectiveness plane for FF/UMEC/VI versus FF/VI (A), and tornado plot of sensitivity and scenario analyses (B). *Assume 100% market share of product. Abbreviations: 6MWT, 6-min walk test; CI, confidence interval; COPD, chronic obstructive pulmonary disease; C$, Canadian dollars; DPI, dry-powder inhaler; FF, fluticasone furoate; FP, fluticasone propionate; ICER, incremental cost-effectiveness ratio; ICS, inhaled corticosteroid; ITT, intent to treat; LABA, long-acting β2-agonist; mMRC, modified Medical Research Council; PSA, probabilistic sensitivity analysis; QALY, quality-adjusted life year; SAL, salmeterol; SITT, single-inhaler triple therapy; UMEC, umeclidinium; VI, vilanterol.

Figure 3

Net benefit acceptability curves for FF/UMEC/VI versus FF/VI. Abbreviations: C$, Canadian dollars; FF, fluticasone furoate; QALY, quality-adjusted life year; UMEC, umeclidinium; VI, vilanterol.

Figure 4

Incremental cost-effectiveness plane for FF/UMEC/VI versus UMEC/VI (A), and tornado plot of sensitivity and scenario analyses (B). *Assume 100% market share of product. Abbreviations: 6MWT, 6-min walk test; CI, confidence interval; COPD, chronic obstructive pulmonary disease; C$, Canadian dollars; DPI, dry-powder inhaler; FF, fluticasone furoate; FP, fluticasone propionate; ICER, incremental cost-effectiveness ratio; ITT, intent to treat; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified Medical Research Council; PSA, probabilistic sensitivity analysis; QALY, quality-adjusted life year; SAL, salmeterol; SITT, single-inhaler triple therapy; UMEC, umeclidinium; VI, vilanterol.

Figure 5

Net benefit acceptability curves for FF/UMEC/VI versus UMEC/VI. Abbreviations: C$, Canadian dollars; FF, fluticasone furoate; QALY, quality-adjusted life year; UMEC, umeclidinium; VI, vilanterol.