Cost-effectiveness modeling of mortality risk reduction comparing two fixed-dose combination triple therapies in moderate-to-very severe chronic obstructive pulmonary disease

Abstract

Two fixed-dose combination triple therapies, budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) 320/14.4/10 μg and fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 μg, have been shown to reduce all-cause mortality in phase III trials. A recent matching adjusted indirect comparison showed greater mortality reduction with BGF versus FF/UMEC/VI. However, the comparative cost-effectiveness of these treatments remains unknown. This study aimed to use a cost-effectiveness model to compare BGF with FF/UMEC/VI in patients with moderate-to-very severe chronic obstructive pulmonary disease (COPD) who are eligible for triple therapy from a UK third party payer perspective. Materials & methods: A cohort-based semi-Markov model was used with the natural progression of COPD defined by four lung function levels. Input parameters included participant characteristics and clinical efficacy parameters derived from the ETHOS and KRONOS trials, the UK general population and published literature. Unit costs were obtained from the UK National Health System Schedule of Reference Costs (2021/2022), the Personal Social Services Research Unit (2022) and published literature. Outputs included an incremental cost-effectiveness ratio, costs, quality-adjusted life years and life years at time horizons of 1 and 5 years. Model inputs and assumptions were subject to deterministic and probabilistic sensitivity and scenario analyses. Results: At both 1- and 5-year time horizons, BGF was less costly (-£7.24 and-£23.03 per patient) and more effective (0.002 and 0.21 quality-adjusted life years per patient) versus FF/UMEC/VI, respectively. Due to a reduced mortality rate, more patients remained on BGF treatment than on FF/UMEC/VI, which induced higher treatment-related costs; however, the latter was offset by decreased end-of-life costs, as BGF avoided more deaths. Conclusion: BGF may improve health outcomes and reduce healthcare costs compared with FF/UMEC/VI in patients with moderate-to-very severe COPD in a UK setting.