ICON Global Health Economics and Outcomes Research, ICON plc, Toronto, ON, M2N 1A2, Canada.
Health Economics and Outcomes Research, GSK, Mississauga, ON, L5R 3G2, Canada.
Respir Med. 2024 Sep;231:107694. doi: 10.1016/j.rmed.2024.107694. Epub 2024 Jun 4.
This cost-utility analysis assessed the long-term clinical and economic benefits of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy vs FF/VI or UMEC/VI from a Quebec societal perspective in patients with chronic obstructive pulmonary disease (COPD) with ≥1 moderate/severe exacerbation in the previous year.
The validated GALAXY disease progression model was utilized, with parameters set to baseline and efficacy data from IMPACT. Treatment costs (2017 Canadian dollars [C$]) were estimated using Quebec-specific unit costs. Costs and health outcomes were discounted at 1.5 %/year. A willingness-to-pay threshold of C$50,000/quality-adjusted life year (QALY) was considered cost-effective. Outcomes modeled were exacerbation rates, QALYs, life years (LYs), costs and incremental cost-effectiveness ratios (ICERs). Subgroup analyses were performed according to prior treatment, exacerbation history in the previous year, and baseline lung function.
Over a lifetime horizon, FF/UMEC/VI resulted in more QALYs and LYs gained, at a small incremental cost compared with FF/VI and UMEC/VI. From a societal perspective, the estimated ICER for the base case was C$18,152/QALY vs FF/VI, and C$15,847/QALY vs UMEC/VI. For the subgroup analyses (FF/UMEC/VI compared with FF/VI and UMEC/VI), ICERs ranged from: C$17,412-25,664/QALY and C$16,493-18,663/QALY (prior treatment); C$15,247-19,924/QALY and C$15,444-28,859/QALY (exacerbation history); C$14,025-34,154/QALY and C$16,083-17,509/QALY (baseline lung function).
FF/UMEC/VI was predicted to improve outcomes and be cost-effective vs both comparators in the base case and all subgroup analyses, and based on this analysis would be an appropriate investment of health service funds in Quebec.
IMPACT trial NCT02164513.
本项成本效用分析从魁北克社会视角出发，评估了糠酸氟替卡松/乌美溴铵/维兰特罗（FF/UMEC/VI）三联疗法相较于 FF/VI 或 UMEC/VI 用于既往 1 年中至少有 1 次中度/重度加重的慢性阻塞性肺疾病（COPD）患者的长期临床和经济效益。
采用经过验证的 GALAXY 疾病进展模型，参数设定为基线值，疗效数据来自 IMPACT 研究。采用魁北克特定的单位成本来估算治疗费用（2017 加元）。成本和健康结果以 1.5%/年贴现。将 50000 加元/质量调整生命年（QALY）作为成本效益的意愿支付阈值。模型中预测的结果为加重率、QALY、生命年（LY）、成本和增量成本效益比（ICER）。根据既往治疗、既往 1 年加重史和基线肺功能进行亚组分析。
在终生范围内，与 FF/VI 和 UMEC/VI 相比，FF/UMEC/VI 可使 QALY 和 LY 获益增加，且增量成本较低。从社会角度来看，基础情况下，FF/UMEC/VI 的估计 ICER 为与 FF/VI 相比为 18152 加元/QALY，与 UMEC/VI 相比为 15847 加元/QALY。对于亚组分析（FF/UMEC/VI 与 FF/VI 和 UMEC/VI 相比），ICER 范围为：与 FF/VI 相比为 17412-25664 加元/QALY，与 UMEC/VI 相比为 16493-18663 加元/QALY（既往治疗）；与 FF/VI 相比为 15247-19924 加元/QALY，与 UMEC/VI 相比为 15444-28859 加元/QALY（既往加重史）；与 FF/VI 相比为 14025-34154 加元/QALY，与 UMEC/VI 相比为 16083-17509 加元/QALY（基线肺功能）。
在基础情况和所有亚组分析中，FF/UMEC/VI 均预测可改善结局并具有成本效益，优于两种对照药物，因此基于该分析，FF/UMEC/VI 可能是魁北克卫生服务资金的一项合理投资。
IMPACT 试验 NCT02164513。
