Cost-effectiveness analysis of a fixed-dose combination of indacaterol and glycopyrronium as maintenance treatment for COPD

Figures & data

Figure 1 Conceptual framework of model: FEV₁; IND/GLY.

Abbreviations: FEV₁, forced expiratory volume in 1 second; GLY, glycopyrronium; IND, indacaterol; LY, life year; QALY, quality-adjusted life year; TDI, Transition Dyspnea Index; SGRQ, St. George’s Respiratory Questionnaire.

Table 1 Clinical data and utility input

Variables	Coefficient	SE	Distribution
Covariance matrix to estimate:^Citation11–Citation13,Citation20
Height
Age	−0.12	0.01	Normal
Gender	−10.53	0.24	Normal
Constant	179.47	0.81	Normal
Smoking status
Age	−0.02	0.00	Normal
Height	0.00	0.00	Normal
Gender	0.08	0.02	Normal
Constant	1.30	0.17	Normal
FEV1 (%)
Age	0.08	0.02	Normal
Height	0.01	0.03	Normal
Smoking status	0.21	0.43	Normal
Gender	3.90	0.54	Normal
Constant	45.78	5.13	Normal
Annual FEV1 decline^Citation26
Smokers	0.06	0.06	Normal
Intermittent smokers	0.04	0.06	Normal
Ex-smokers	0.03	0.05	Normal
FEV1 improvement^Citation11–Citation13,Citation30
IND/GLY	0.19	0.02	Normal
SFC	0.16	0.02	Normal
Tiotropium	0.13	0.01	Normal
Utility input in EQ-5D regression^Citation31
Constant	0.69	0.04	Normal
Gender (male versus female)	0.06	0.01	Normal
Post-bronchodilator therapy	0.00	0.00	Normal
FEV1 % predicted
Number of emergency department visits not resulting in hospital admission in the previous year	−0.03	0.01	Normal
Number of hospital admissions in the previous year	−0.02	0.01	Normal
Number of concomitant diseases in the previous year	−0.01	0.00	Normal
BMI	0.00	0.00	Normal
Excess mortality for COPD population^Citation27
Hazard ratio	1.02	0.01	Lognormal

Abbreviations: BMI, body mass index; EQ-5D, European Quality of Life-5 dimensions; FEV₁, forced expiratory volume in 1 second; GLY, glycopyrronium; IND, indacaterol; SFC, salmeterol/fluticasone combination.

Table 2 Efficacy data input

Variables	Mean (L)	SE	Distribution
FEV1 improvement^Citation12,Citation13
IND/GLY	0.26	0.026	Normal
Tiotropium	0.13	0.016
SFC	0.16	0.013
Exacerbation rate ratios^Citation12,Citation13
IND/GLY	0.61	0.10	Lognormal
Tiotropium	0.91	0.10
SFC	0.75	0.10
Withdrawal (assumption)
IND/GLY	0.04
Tiotropium	0.04
SFC	0.04

Abbreviations: FEV₁, forced expiratory volume in 1 second; GLY, glycopyrronium; IND, indacaterol; SFC, salmeterol/fluticasone combination.

Table 3 Cost inputs

Variables	Mean	SE	Distribution
Maintenance cost (US$)
GOLD I	210.65	14.16	Gamma
GOLD II	242.72	10.89	Gamma
GOLD III	213.09	28.74	Gamma
GOLD IV	341.83	28.60	Gamma
Exacerbation cost (US$)
Non-severe exacerbation	68.89	1.75	Gamma
Severe exacerbation	3,529.37	120.18	Gamma
Drug costs (daily cost, US$)
IND/GLY	2.02
Tiotropium	1.67
SFC	1.50

Abbreviations: GLY, glycopyrronium; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IND, indacaterol; SFC, salmeterol/fluticasone combination.

Table 4 Base-case CE results for IND/GLY versus tiotropium and IND/GLY versus SFC

Variables	IND/GLY versus tiotro					IND/GLY versus SFC
	1 year	3 years	5 years	10 years	Lifetime	1 year	3 years	5 years	10 years	Lifetime
Incremental cost (US$)	37	98	155	278	463	160	442	703	1,235	1,894
Incremental LY	0.00	0.00	0.00	0.04	0.12	0.00	0.01	0.01	0.05	0.19
Incremental QALY	0.00	0.01	0.01	0.03	0.08	0.00	0.01	0.01	0.04	0.13
Exacerbations avoided	0.04	0.14	0.24	0.43	0.66	0.04	0.14	0.24	0.43	0.66
ICER per LY gained	174,714	38,393	19,756	8,388	4,012	573,139	113,021	53,273	22,899	10,223
ICER per QALY gained	48,224	27,266	19,070	10,626	5,899	142,046	77,973	52,212	29,015	14,991
ICER per exacerbation avoided	903.69	693.73	657.85	643.49	701.45	3,952.68	3,114.21	2,986.04	2,854.85	2,868.62

Abbreviations: CE, cost-effectiveness; GLY, glycopyrronium; ICER, incremental cost-effectiveness ratio; IND, indacaterol; LY, life year; QALY, quality-adjusted life year; SFC, salmeterol/fluticasone combination.

Figure 2 Incremental CE scatterplot showing cost per QALY gained through the administration of IND/GLY compared to (A) tiotropium and (B) SFC.

Abbreviations: CE, cost-effectiveness; GLY, glycopyrronium; IND, indacaterol; QALY, quality-adjusted life year; SFC, salmeterol/fluticasone combination.

Figure 3 CEAC per QALY gained from IND/GLY.

Abbreviations: CEAC, cost-effectiveness acceptability curve; GDP, gross domestic product; GLY, glycopyrronium; IND, indacaterol; LABA, long-acting beta-2 agonist; LAMA, long-acting muscarinic antagonist; QALY, quality-adjusted life year; SFC, salmeterol/fluticasone combination; WTP, willingness-to-pay.

Figure S1 One-way sensitivity analysis.

Note: (A) IND/GLY versus tiotropium and (B) IND/GLY versus SFC.

Abbreviations: FEV₁, forced expiratory volume in 1 second; GLY, glycopyrronium; ICER, incremental cost-effectiveness ratio; IND, indacaterol; QALY, quality-adjusted life year; SFC, salmeterol/fluticasone combination.

BatemanEDFergusonGTBarnesNDual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE studyEur Respir J20134261484149423722616

 PubMed Web of Science ®Google Scholar

WedzichaJADecramerMFickerJHAnalysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium (SPARK): a randomised, double-blind, parallel-group studyLancet Respir Med20131319920924429126

 PubMed Web of Science ®Google Scholar

DahlRJadayelDAlagappanVKTChenUBanerjiDEfficacy and safety of QVA149 compared to the concurrent administration of its monocomponents indacaterol and glycopyrronium: the BEACON studyInt J Chron Obstruct Pulmon Dis2013850150824159259

 PubMed Web of Science ®Google Scholar

ScanlonPDConnettJEWallerLASmoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health studyAm J Respir Crit Care Med20001612 pt 138139010673175

 PubMed Web of Science ®Google Scholar

DahlRJadayelDAlagappanVChenHBanerjiDEfficacy and safety of QVA149 compared to the concurrent administration of its monocomponents indacaterol and glycopyrronium: the BEACON study [Corrigendum]International Journal of Chronic Obstructive Pulmonary Disease20149

 Web of Science ®Google Scholar

Rutten-van MolkenMPOostenbrinkJBTashkinDPBurkhartDMonzBUDoes quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages?Chest200613041117112817035446

 PubMed Web of Science ®Google Scholar

LindbergALarssonLGMuellerovaHRonmarkELundbackBUp-to-date on mortality in COPD – report from the OLIN COPD studyBMC Pulm Med201212122230685

 PubMed Web of Science ®Google Scholar

VogelmeierCFBatemanEDPallanteJEfficacy and safety of once-daily QVA149 compared with twice-daily salmeterol-fluticasone in patients with chronic obstructive pulmonary disease (ILLUMINATE): a randomised, double-blind, parallel group studyLancet Respir Med201311516024321804

 PubMed Web of Science ®Google Scholar