在英国，未控制的哮喘患者中单吸入器超细布地奈德/福莫特罗富马酸盐/格隆溴铵的成本效益。

Cost-effectiveness of single-inhaler extrafine beclometasone dipropionate/formoterol fumarate/glycopyrronium in patients with uncontrolled asthma in England.

机构信息

Chiesi Farmaceutici SpA, Parma, Italy.

IQVIA Solutions BV, Amsterdam, the Netherlands.

出版信息

Respir Med. 2022 Sep;201:106934. doi: 10.1016/j.rmed.2022.106934. Epub 2022 Jul 19.

DOI:10.1016/j.rmed.2022.106934

PMID:35872377

Abstract

BACKGROUND

In patients with asthma that is uncontrolled by a medium- or high-dose inhaled corticosteroid (ICS) plus long-acting β-agonist (LABA), a maintenance therapy option is the addition of a long-acting muscarinic agonist, either via multiple inhalers, or single-inhaler triple therapy (SITT). One SITT is the extrafine formulation of beclometasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). We used data from two 52-week clinical trials (TRIMARAN and TRIGGER), both conducted in adults with asthma uncontrolled by ICS/LABA, to investigate the cost-effectiveness of BDP/FF/G.

METHODS

A Markov cohort state transition model (focusing on exacerbations) was used to investigate the cost-effectiveness of medium- or high-dose BDP/FF/G vs medium- or high-dose BDP/FF, and high-dose BDP/FF/G vs high-dose BDP/FF + tiotropium. The model analysed cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER), and was developed from the England National Health Service perspective (2020 costs). Uncertainty of the inputs was estimated using one-way and probabilistic sensitivity analyses.

RESULTS

Both medium- and high-dose BDP/FF/G were cost-effective vs BDP/FF, with ICERs of £12,224 and £15,587 per QALY gained. High-dose BDP/FF/G was dominant vs BDP/FF + tiotropium, as it was both cheaper and gained QALYs. Sensitivity analyses were consistent with the base model: medium- and high-dose BDP/FF/G had 94.3% and 88.3% likelihoods to be cost-effective vs BDP/FF; high-dose BDP/FF/G had 100% likelihood to be a dominant strategy vs BDP/FF + tiotropium.

CONCLUSIONS

Both medium- and high-dose BDP/FF/G were cost-effective vs medium- and high-dose BDP/FF in adults with asthma that was uncontrolled by ICS/LABA. In addition, high-dose BDP/FF/G was a dominating strategy to high-dose BDP/FF + tiotropium.

CLINICALTRIALS

GOV: NCT02676076 and NCT02676089.

摘要

背景

在吸入中高剂量糖皮质激素（ICS）加长效β激动剂（LABA）控制不佳的哮喘患者中，一种维持治疗选择是加用长效抗胆碱能药物，可通过多种吸入器或单吸入器三联疗法（SITT）给药。一种 SITT 是丙酸倍氯米松/富马酸福莫特罗/格隆溴铵的超细制剂（BDP/FF/G）。我们使用了两项为期 52 周的临床试验（TRIMARAN 和 TRIGGER）的数据，这些试验均在 ICS/LABA 控制不佳的哮喘成人患者中进行，旨在研究 BDP/FF/G 的成本效益。

方法

采用 Markov 队列状态转移模型（专注于加重），调查中高剂量 BDP/FF/G 与中高剂量 BDP/FF，以及高剂量 BDP/FF/G 与高剂量 BDP/FF+噻托溴铵相比的成本效益。该模型分析了成本、质量调整生命年（QALY）和增量成本效益比（ICER），并从英国国家医疗服务体系的角度（2020 年成本）进行了开发。采用单因素和概率敏感性分析来估计输入的不确定性。

结果

中高剂量 BDP/FF/G 与 BDP/FF 相比均具有成本效益，每获得一个质量调整生命年的增量成本效益比分别为 12224 英镑和 15587 英镑。高剂量 BDP/FF/G 与 BDP/FF+噻托溴铵相比具有优势，因为它既更便宜又能获得质量调整生命年。敏感性分析与基础模型一致：中高剂量 BDP/FF/G 分别有 94.3%和 88.3%的可能性比 BDP/FF 更具成本效益；高剂量 BDP/FF/G 与 BDP/FF+噻托溴铵相比具有 100%的可能性成为优势策略。