Fenwick Elisabeth, Martin Alan, Schroeder Melanie, Mealing Stuart J, Solanke Oyinkansola, Risebrough Nancy, Ismaila Afisi S
ICON Health Economics, ICON plc., Abingdon, UK.
Value Evidence and Outcomes, GlaxoSmithKline plc., Uxbridge, UK.
ERJ Open Res. 2021 Mar 22;7(1). doi: 10.1183/23120541.00480-2020. eCollection 2021 Jan.
UK management costs for COPD, estimated at £1.9 billion/year, are rising. In the FULFIL (Lung Function and Quality of Life Assessment in Chronic Obstructive Pulmonary Disease with Closed Triple Therapy) study, single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (100/62.5/25 µg) improved clinical outcomes budesonide/formoterol (400/12 µg) in patients with symptomatic COPD at risk of exacerbations. We assessed the cost-effectiveness of fluticasone furoate/umeclidinium/vilanterol budesonide/formoterol for treating COPD from a UK National Health Service perspective. A model was developed combining a trial-based and Markov component and populated with baseline and treatment effect data from FULFIL, together with UK healthcare resource costs and disease-related utilities. Costs per life year and per quality-adjusted life year gained (costing year 2017) for fluticasone furoate/umeclidinium/vilanterol budesonide/formoterol were calculated for a lifetime horizon. Results were explored using deterministic sensitivity, scenario and probabilistic analyses. Fluticasone furoate/umeclidinium/vilanterol was associated with gains in life years (0.533) and quality-adjusted life years (0.506) budesonide/formoterol, but at slightly increased total costs (£26 416 £25 860). This translated to incremental cost-effectiveness ratios of £1042/life year and £1098/quality-adjusted life year for fluticasone furoate/umeclidinium/vilanterol budesonide/formoterol. In scenario analyses, incremental cost-effectiveness ratios ranged from dominant to £1547/quality-adjusted life year gained. Fluticasone furoate/umeclidinium/vilanterol provides a cost-effective treatment option budesonide/formoterol for patients with symptomatic COPD in the UK.
英国慢性阻塞性肺疾病（COPD）的管理成本估计为每年19亿英镑，且在不断上升。在FULFIL（慢性阻塞性肺疾病三联吸入疗法的肺功能与生活质量评估）研究中，对于有加重风险的症状性COPD患者，糠酸氟替卡松/乌美溴铵/维兰特罗（100/62.5/25μg）单吸入器三联疗法改善临床结局的效果优于布地奈德/福莫特罗（400/12μg）。我们从英国国家医疗服务体系的角度评估了糠酸氟替卡松/乌美溴铵/维兰特罗与布地奈德/福莫特罗治疗COPD的成本效益。开发了一个结合基于试验和马尔可夫成分的模型，并用来自FULFIL的基线和治疗效果数据，以及英国医疗资源成本和疾病相关效用数据进行填充。针对终身时间范围，计算了糠酸氟替卡松/乌美溴铵/维兰特罗与布地奈德/福莫特罗每获得一个生命年和每获得一个质量调整生命年的成本（成本计算年份为2017年）。使用确定性敏感性分析、情景分析和概率分析来探究结果。糠酸氟替卡松/乌美溴铵/维兰特罗与布地奈德/福莫特罗相比，可使生命年增加（0.533）和质量调整生命年增加（0.506），但总成本略有增加（26416英镑对25860英镑）。这转化为糠酸氟替卡松/乌美溴铵/维兰特罗相对于布地奈德/福莫特罗每生命年的增量成本效益比为1042英镑，每质量调整生命年为1098英镑。在情景分析中，增量成本效益比范围从占优到每获得一个质量调整生命年1547英镑。对于英国有症状的COPD患者，糠酸氟替卡松/乌美溴铵/维兰特罗是一种具有成本效益的治疗选择，优于布地奈德/福莫特罗。
