Cost-effectiveness analysis: fluticasone furoate/umeclidinium/vilanterol for the treatment of moderate to severe chronic obstructive pulmonary disease from the perspective of the Chilean public health system

ABSTRACT

Background

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease characterized by long-term breathing problems and airflow limitations. International guidelines recommend using bronchodilators like long-acting beta- and muscarinic antagonists, and inhalational corticosteroids.

Objectives

The cost-effectiveness of single-inhaler triple therapy containing fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) was compared to the treatments Fluticasone Furoate/Vilanterol (FF/VI), Umeclidinio/Vilanterol (UMEC/VI) and Fluticasone Propionate 250 mcg/Salmeterol 25mcg + Tiotropio 18 mcg (FP/SAL/TIO) for patients with COPD from the Chilean public health system perspective.

Methods

A cost-effectiveness analysis was performed, including a deterministic and probabilistic sensitivity analysis over a 25-year time horizon. Two scenarios were assessed to study the effect of a 3%-discount for costs and outcomes on FF/UMEC/VI.

Results

The incremental cost-effectiveness (ICER) of FF/UMEC/VI versus FF/VI was $10,076/QALY, being a cost-effective alternative to a threshold of one Gross Domestic Product per capita (GDPpc), while versus FP/SAL/TIO the ICER increased to $50,288/QALY, showing to be a non-cost effective alternative to 1 GDPpc, but at a threshold of 3 GDPpc.

Conclusion

FF/UMEC/VI appears to be a cost-effective intervention for treating COPD compared to FF/VI. However, FF/UMEC/VI compared to FP/SAL/TIO showed an ICER above the threshold of 1 GDPpc, but, in comparison with lower price, the ICER was below 3 GDPpc.

KEYWORDS:

• Cost-effectiveness analysis
• Chronic obstructive pulmonary disease
• single inhaler triple therapy
• quality-adjusted life years
• Chile

Supplementary material

Supplemental data for this article can be accessed here

Authors’ contribution

Conceived and designed the experiments: C Balmaceda, M Espinoza

Project Management: C Balmaceda, M Espinoza

Model adaptation: C Balmaceda, M Espinoza

Validation of data: C Balmaceda, M Espinoza, T Abbott

Analyzed the data: C Balmaceda, M Espinoza

Contributed reagents/materials/ analysis tools: C Balmaceda, M Espinoza, T Abbott

Original Drafting: C Balmaceda, M Espinoza, A Peters

Drafting-Reviewing and Editing: C Balmaceda, M Espinoza, A Peters, T Abbott

Proofreading: M Espinoza, A Peters

All authors agree for the final version of the manuscript to be published.

Declaration of interest

The researchers declare that they have carried out this study within the framework of their salary conditions with the university and in no case have they received specific additional incentives for this study. C Balmaceda has received fees from Novartis and Novo Nordisk for educational services. M Espinoza has received fees from Merck, Grunenthal, Boehringer Ingelheim, Novartis, MSD, Abbvie, Roche, for training activities and presentations. T Abbott has received fees from Abbvie and Boehringer Ingelheim for educational services and presentations. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The present study was financed by GlaxoSmithKline and commissioned to Pontificia Universidad Católica de Chile under strict independence clauses.