Cost-Effectiveness Analysis of a Once-Daily Single-Inhaler Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease (COPD) Using the FULFIL Trial: A Spanish Perspective
Por:
Schroeder M, Benjamin N, Atienza L, Biswas C, Martin A, Whalen JD, Izquierdo Alonso JL, Riesco Miranda JA, Soler-Cataluña JJ, Huerta A and Ismaila AS
Publicada:
1 ene 2020
Ahead of Print:
10 jul 2020
Resumen:
Purpose: To evaluate the cost-effectiveness of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) vs twice-daily budesonide/formoterol (BUD/FOR) in patients with symptomatic chronic obstructive pulmonary disease (COPD) at risk of exacerbations, from the Spanish National Healthcare System perspective.
Patients and Methods: The validated GALAXY-COPD model was used to simulate disease progression and predict healthcare costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 3-year time horizon for a Spanish population. Patient characteristics from published literature were supplemented by data from FULFIL (NCT02345161), which compared FF/UMEC/VI vs BUD/FOR in patients with symptomatic COPD at risk of exacerbations. Treatment effects, extrapolated to 3 years, were based on Week 24 results in the FULFIL intent-to-treat population, including change in forced expiratory volume in 1 second, St. George's Respiratory Questionnaire score, and exacerbation rates. Treatment, exacerbations, and COPD management costs (2019(sic)) were informed by Spanish public sources and published literature. A 3% discount rate for costs and benefits was applied. One-way sensitivity and scenario analyses, and probabilistic sensitivity analysis (PSA), were performed.
Results: FF/UMEC/VI treatment led to fewer moderate and severe exacerbations (2.126 and 0.306, respectively) vs BUD/FOR (2.608 and 0.515, respectively), with a mean incremental cost of (sic)69 and gain of 0.107 QALYs, which resulted in an ICER of (sic)642 per QALY gained. In sensitivity analyses, the ICER was most sensitive to treatment effect variations in exacerbations and healthcare resource utilization/event costs. Overall, 95% of 1000 PSA simulations resulted in an ICER less than (sic)11,000 per QALY gained for FF/UMEC/VI vs BUD/FOR, confirming robustness of the results. The probability of FF/UMEC/VI being cost-effective vs BUD/FOR was 100% at a willingness-to-pay threshold of (sic)30,000 per QALY gained.
Conclusion: At the accepted Spanish ICER threshold of (sic)30,000, FF/UMEC/VI represents a cost-effective treatment option vs BUD/FOR in patients with symptomatic COPD at risk of exacerbations.
Filiaciones:
Schroeder M:
Value Evidence and Outcomes, GlaxoSmithKline plc., Brentford, UK
Benjamin N:
Global Health Economics, ICON plc., Boston, MA, USA
Atienza L:
Market Access, GlaxoSmithKline SA, Madrid, Spain
Biswas C:
Global Health Economics, ICON plc., Bengaluru, Karnataka, India
Martin A:
Value Evidence and Outcomes, GlaxoSmithKline plc., Uxbridge, UK
Whalen JD:
Global Health Economics, ICON plc., Abingdon, UK
Izquierdo Alonso JL:
Pneumology, Hospital Universitario de Guadalajara, Guadalajara, Spain
Riesco Miranda JA:
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
:
Pneumology Department, Hospital Arnau de Vilanova-Lliria (Valencia), Valencia, Spain
Huerta A:
Market Access, GlaxoSmithKline SA, Madrid, Spain
Ismaila AS:
Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
Green Published, gold
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