Cost Efficacy of Single- Versus Multiple-Inhaler Triple Therapy for COPD

In the INTREPID trial, investigators found a clinical benefit for once-daily single-inhaler therapy with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) when compared with non-ELLIPTA multiple-inhaler triple therapy (MITT) in patients with symptomatic chronic obstructive pulmonary disease (COPD).

Subsequently, researchers led by David Halpin performed a cost-efficacy analysis of FF/UMEC/VI versus non-ELLIPTA MITT in the context of the UK National Health Service system. In their trial, they concluded FF/UMEC/VI would improve outcomes  and reduce costs for patients with symptomatic COPD compared with non-ELLIPTA MITT. Their findings were published in the International Journal of Chronic Obstructive Pulmonary Disease.

Single-Inhaler Triple Therapy Superior to MITT in COPD

The team inputted baseline characteristics, treatment effect parameters (forced expiratory volume in 1 second and St. George’s Respiratory Questionnaire score), and discontinuations from the INTREPID study into the validated GALAXY COPD disease progression model. Healthcare resource utilization and drug costs were evaluated against the British pound in 2020 with a 3.5% discount.

Primary analyses end points over a lifetime horizon included exacerbation rates, total costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio per QALY. A sensitivity analyses was performed to validate initial results.

Reportedly, FF/UMEC/VI yielded an additional 0.174 life years (95% CI, 0.024-0.344) and 0.253 life QALYs (95% CI, 0.167-0.346), approximately 2 and 3 months, respectively, with a cost reduction of £1764 (95% CI, -2600 to -678) per patient compared with non-ELLIPTA MITT.

Across the initial and sensitivity analyses, fluticasone furoate, umeclidinium, and vilanterol single-inhaler triple therapy remained the optimal treatment option for both outcomes and cost-effectiveness.

Ultimately, Halpin and colleagues suggested “[single-inhaler triple therapy] may help to reduce the clinical and economic burden of COPD and should be considered by physicians as a preferred treatment option.”

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