Martin Alan, Shah Dhvani, Ndirangu Kerigo, Anley Glenn A, Okorogheye Gabriel, Schroeder Melanie, Risebrough Nancy, Ismaila Afisi S
Value Evidence and Outcomes, GlaxoSmithKline, Uxbridge, UK.
ICON Plc, Health Economics, New York, NY, USA.
ERJ Open Res. 2022 Feb 21;8(1). doi: 10.1183/23120541.00333-2021. eCollection 2022 Jan.
The IMPACT trial demonstrated superior outcomes following 52 weeks of once-daily single-inhaler treatment with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) (100/62.5/25 μg) compared with once-daily FF/VI (100/25 μg) or UMEC/VI (62.5/25 μg). This study evaluated the cost-effectiveness of FF/UMEC/VI compared with FF/VI or UMEC/VI for the treatment of chronic obstructive pulmonary disease (COPD) from a UK National Health Service perspective.
Patient characteristics and treatment effects from IMPACT were populated into a hybrid decision tree/Markov economic model. Costs (GB£ inflated to 2018 equivalents) and health outcomes were modelled over a lifetime horizon, with a discount rate of 3.5% per annum applied to both. Sensitivity analyses were performed to test the robustness of key assumptions and input parameters.
Compared with FF/VI and UMEC/VI, FF/UMEC/VI provided an additional 0.296 and 0.145 life years (LYs) (discounted) and 0.275 and 0.118 quality-adjusted life years (QALYs), at an additional cost of £1129 and £760, respectively. Incremental cost-effectiveness ratios (ICERs) for FF/UMEC/VI were £4104/QALY and £3809/LY gained FF/VI and £6418/QALY and £5225/LY gained UMEC/VI. At a willingness-to-pay threshold of £20 000/QALY, the probability that FF/UMEC/VI was cost-effective was 96% FF/VI and 74% UMEC/VI. Results were similar in a subgroup of patients recommended triple therapy in the 2019 National Institute for Health and Care Excellence COPD guideline.
FF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a cost-effective option compared with FF/VI or UMEC/VI for patients with symptomatic COPD and a history of exacerbations in the UK at recognised cost-effectiveness threshold levels.
IMPACT试验表明，与每日一次使用氟替卡松糠酸酯（FF）/维兰特罗（VI）（100/25μg）或乌美溴铵（UMEC）/维兰特罗（VI）（62.5/25μg）相比，每日一次使用氟替卡松糠酸酯（FF）/乌美溴铵（UMEC）/维兰特罗（VI）（100/62.5/25μg）进行单吸入器治疗52周后，疗效更佳。本研究从英国国家医疗服务体系的角度评估了FF/UMEC/VI与FF/VI或UMEC/VI相比治疗慢性阻塞性肺疾病（COPD）的成本效益。
将IMPACT试验中的患者特征和治疗效果纳入混合决策树/马尔可夫经济模型。对成本（按2018年等值进行通胀后的英镑）和健康结局进行终身模拟，两者均应用3.5%的年贴现率。进行敏感性分析以检验关键假设和输入参数的稳健性。
与FF/VI和UMEC/VI相比，FF/UMEC/VI分别额外增加了0.296和0.145个生命年（LYs，贴现后）以及0.275和0.118个质量调整生命年（QALYs），额外成本分别为1129英镑和760英镑。FF/UMEC/VI的增量成本效益比（ICERs）分别为每获得一个QALY 4104英镑和每获得一个LY 3809英镑（与FF/VI相比），以及每获得一个QALY 6418英镑和每获得一个LY 5225英镑（与UMEC/VI相比）。在每QALY支付意愿阈值为20000英镑时，FF/UMEC/VI具有成本效益的概率分别为96%（与FF/VI相比）和74%（与UMEC/VI相比）。在2019年英国国家卫生与保健优化研究所COPD指南中推荐三联疗法的患者亚组中，结果相似。
对于英国有症状的COPD且有加重病史的患者，在公认的成本效益阈值水平下，FF/UMEC/VI单吸入器三联疗法改善了健康结局，与FF/VI或UMEC/VI相比是一种具有成本效益的选择。
