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) (NCT2164513).

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:

• chronic obstructive pulmonary disease
• cost-effectiveness
• single-inhaler triple therapy
• quality-adjusted life years
• Canada

Acknowledgments

An abstract of the FF/UMEC/VI versus FF/VI data from this paper was presented at the ERS 2018 conference as a poster presentation with interim findings. The poster’s abstract was published in the European Respiratory Journal: https://erj.ersjournals.com/content/52/suppl_62/PA3154. An additional abstract of the FF/UMEC/VI versus UMEC/VI data from this paper was presented at the ISPOR EU 2018 conference as a poster presentation with interim findings. The poster’s abstract was published in Value in Health: https://doi.org/10.1016/j.jval.2018.09.2451. Trademarks are the property of their respective owners. Editorial support (in the form of writing assistance, collating author comments, assembling tables/figures, grammatical editing and referencing) was provided by Molly Macpherson, BSc, of Gardiner–Caldwell Communications (Macclesfield, UK), and was funded by GlaxoSmithKline plc. This study was funded by GlaxoSmithKline plc (IMPACT ClinicalTrials.gov number, NCT2164513; CTT116855).

Abbreviations

6MWT, 6-min walk test; C$, Canadian dollars; CADTH, Canadian Agency for Drugs and Technology in Health; CAT, COPD Assessment Test; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ECLIPSE, Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points; ER, emergency room; FEV₁, forced expiratory volume in 1 s; FF, fluticasone furoate; HRQoL, health-related quality of life; ICER, incremental cost-effectiveness ratio; ICS, inhaled corticosteroid; IMPACT, InforMing the PAthway of COPD Treatment; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; LY, life year; mMRC, modified Medical Research Council; ODB, Ontario Drug Benefit; QALY, quality-adjusted life year; SITT, single-inhaler triple therapy; SGRQ, St George’s Respiratory Questionnaire; SGRQ-C, SGRQ for COPD patients; TORCH, Towards a Revolution in COPD Health; UMEC, umeclidinium; VI, vilanterol.

Disclosure

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.