Cost-effectiveness of twice-daily indacaterol/glycopyrrolate inhalation powder for the treatment of moderate to severe COPD in the US

Figures & data

Figure 1 Model structure.

Table 1 Population and health-state inputs

Parameter	Value	Reference
Discount rate for costs	3.0%	Assumption
Discount rate for outcomes	3.0%	Assumption
Mean (SD) FEV1 at baseline	1.520 (0.4771)	26
Mean (SD) percentage predicted FEV1 at baseline	54.9% (13.3%)	26
Annual absolute rate of decline in percentage predicted FEV1	−1.0%	19
Utility
Mild	0.8971	18
Moderate	0.7551	18
Severe	0.7481	18
Very severe	0.5493	18
Probability of mortality per cycle
Mild	0.276%	27
Moderate	0.276%	27
Severe	0.551%	27
Very severe	2.19%	27
Rate of non-severe exacerbations per cycle
Mild	0.17	25
Moderate	0.17	25
Severe	0.25	25
Very severe	0.34	25
Rate of severe exacerbations per cycle
Mild	0.03	24
Moderate	0.03	24
Severe	0.06	24
Very severe	0.12	24
Length of a non-severe exacerbation	14 days	23
Length of a severe exacerbation	28 days	23
Utility decline associated with a non-severe exacerbation	15%	31
Utility decline associated with a severe exacerbation	50%	31
Cost associated with a non-severe exacerbation	$301	1, 23, 29, 30, 33, 34
Cost associated with a severe exacerbation	$10,343	1, 23, 29, 30, 33, 34
Cost per pneumonia episode	$5,240	32

Table 2 Comparator-specific inputs

Comparator	Difference from placebo in mean CFB to week 12 in FEV1		WAC per 30 days^Citation33	12-week probability of pneumonia episode		Difference from placebo SGRQ response rate at 12 weeks
	Value	Reference	Value	Value (%)	Reference	Value (%)	Reference
Indacaterol/glycopyrrolate	0.223	11	$340.20	0.0	11	21.4	11
Tiotropium bromide/olodaterol	0.164	28	$340.93	0.8	15	20.6	28
Tiotropium	0.110	25	$368.20	0.0	35	18.5	25
Fluticasone/salmeterol	0.160	20	$361.40	1.6	36	No data	20
Budesonide/formoterol	0.090	20	$308.68	0.9	37	No data	20
Aclidinium	0.110	25	$322.17	0.0	38	10.3	25
Fluticasone/vilanterol	0.199	22	$321.74	1.4	39	No data	22
Umeclidinium/vilanterol	0.195	21	$340.93	0.0	21	8.0	21
Glycopyrrolate/formoterol	0.127	17	$334.62	0.0	17	11.0	17
Placebo	0.000	N/A	$0.00	0.0	N/A	0.0	N/A

Note: All costs are presented in USD (2017).

Abbreviations: CFB, change from baseline; N/A, not applicable; SGRQ, St George’s Respiratory Questionnaire; WAC, wholesale acquisition cost.

Table 3 LY and QALY resultsa

Comparator	Total cost	Incremental cost vs placebo	LYs	Incremental LYs vs placebo	QALYs	Incremental QALYs vs placebo	Incremental cost per LY gained	ICER (incremental cost per QALY gained)	ICER range containing 95% of PSA results
Indacaterol/glycopyrrolate	$23,375	$14,010	4.463	0.048	3.294	0.201	$292,817	$69,665	$51,121–$119,985
Tiotropium bromide/olodaterol	$24,472	$15,107	4.457	0.042	3.253	0.160	$356,005	$94,423	$68,724–$159,787
Tiotropium	$25,507	$16,142	4.448	0.034	3.211	0.118	$478,264	$136,948	$99,438–$224,403
Fluticasone/salmeterol	$26,499	$17,134	4.457	0.042	3.250	0.157	$409,411	$109,117	$73,995–$198,821
Budesonide/formoterol	$23,397	$14,033	4.444	0.029	3.191	0.098	$475,877	$143,448	$101,379–$236,271
Aclidinium	$23,016	$13,651	4.448	0.034	3.211	0.118	$404,453	$115,813	$78,074–$202,666
Fluticasone/vilanterol	$23,944	$14,579	4.461	0.046	3.277	0.184	$317,947	$79,214	$57,884–$132,471
Umeclidinium/vilanterol	$23,534	$14,169	4.460	0.045	3.274	0.181	$311,420	$78,156	$57,769–$129,245
Glycopyrrolate/formoterol	$23,332	$13,967	4.452	0.037	3.223	0.32	$385,427	$107,161	$79,001–$180,350
Placebo	$9,365	Reference	4.415	Reference	3.093	Reference	Reference	Reference

Notes:

a All costs and outcomes represent discounted values over the 5-year model time horizon. All costs are presented in USD (2017).

Abbreviations: ICER, incremental cost-effectiveness ratio; LY, life-years; PSA, probabilistic sensitivity analysis; QALY, quality-adjusted life year.

Table 4 COPD-specific resultsa

Comparator	Incremental cost per 100 mL decline in FEV1 avoided	Incremental 12-week cost per SGRQ responder gained at 12 weeks	Incremental cost per severe exacerbation avoided	Incremental cost per AE pneumonia episode avoided
Indacaterol/glycopyrrolate	$290	$3,518	$87,686	Equal AEsb
Tiotropium bromide/olodaterol	$425	$3,906	$113,218	Dominated
Tiotropium	$677	$4,602	$163,270	Equal AEsb
Fluticasone/salmeterol	$494	a	$130,759	Dominated
Budesonide/formoterol	$720	a	$166,307	Dominated
Aclidinium	$573	$7,023	$138,072	Equal AEsb
Fluticasone/vilanterol	$338	a	$97,177	Dominated
Umeclidinium/vilanterol	$335	$9,481	$95,645	Equal AEsb
Glycopyrrolate/formoterol	$519	$6,862	$129,082	Equal AEsb
Placebo	Reference	Reference	Reference	Reference

Notes:

a SGRQ data not available at the time of analysis.

b Assumed no higher rate of pneumonia on treatment vs placebo. Dominated, higher rate of pneumonia vs placebo and higher cost vs placebo. All costs are presented in USD (2017).

Abbreviations: AE, adverse event; SGRQ, St George’s Respiratory Questionnaire.

Figure 2 OWSA tornado chart for cost per QALY gained for IND/GLY 27.5/15.6 µg vs placebo.^a

Notes: ^aChart limited to the top 20 most influential parameters. All costs are presented in USD (2017).

Abbreviations: GLY, glycopyrrolate; IND, indacaterol; OWSA, one-way sensitivity analysis; QALY, quality-adjusted life year; WAC, wholesale acquisition cost.

Figure 3 Cost-effectiveness acceptability curve.

Note: All costs are presented in USD (2017).

Red Book OnlineTruven Health Analytics2017 Available from: https://truvenhealth.com/Products/Micromedex/Product-Suites/Clinical-Knowledge/RED-BOOKAccessed November 14, 2018

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