Cost-Effectiveness of Single- versus Multiple-Inhaler Triple Therapy in a UK COPD Population: The INTREPID Trial

Abstract

Purpose The 24-week INTREPID trial demonstrated the clinical benefits of once-daily single-inhaler triple therapy (SITT) with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) versus non-ELLIPTA multiple-inhaler triple therapy (MITT) in patients with symptomatic chronic obstructive pulmonary disease (COPD). This analysis assessed the cost-effectiveness of FF/UMEC/VI versus non-ELLIPTA MITT for the treatment of symptomatic COPD from a United Kingdom (UK) National Health Service (NHS) perspective. Patients and Methods The analysis was conducted using the validated GALAXY COPD disease progression model. Baseline characteristics, treatment effect parameters (forced expiratory volume in 1 second and St. George’s Respiratory Questionnaire score [derived from exploratory COPD Assessment Test score mapping]), and discontinuation data from INTREPID were used to populate the model. UK healthcare resource and drug costs (2020 British pounds) were applied, and costs and outcomes were discounted at 3.5%. Analyses were conducted over a lifetime horizon from a UK NHS perspective. Model outputs included exacerbation rates, total costs, life years (LYs), quality-adjusted LYs (QALYs) and incremental cost-effectiveness ratio per QALY. Sensitivity analyses were conducted to assess the robustness of the results by varying parameter values and assumptions. Results Over a lifetime horizon, FF/UMEC/VI provided an additional 0.174 (95% confidence interval [CI]: 0.024, 0.344) LYs (approximately 2 months), and 0.253 (95% CI: 0.167, 0.346) QALYs (approximately 3 months), at a cost saving of £1764 (95% CI: −£2600, −£678) per patient, compared with non-ELLIPTA MITT. FF/UMEC/VI remained the dominant treatment option, meaning greater benefits at lower costs, across all scenario and sensitivity analyses. Conclusion Based on this analysis, in a UK setting, FF/UMEC/VI would improve health outcomes and reduce costs compared with non-ELLIPTA MITT for the treatment of patients with symptomatic COPD. SITT may help to reduce the clinical and economic burden of COPD and should be considered by physicians as a preferred treatment option.

Benefit of prompt initiation of single-inhaler fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) in patients with COPD in England following an exacerbation: a retrospective cohort study

“…Once-daily SITT with FF/UMEC/VI has previously been shown to be associated with a lower rate of moderate/severe exacerbations vs. dual therapy (FF/VI or UMEC/VI) [ 6 ] and significant improvements in lung function and health status vs. MITT [ 19 ]. FF/UMEC/VI has also been found to be a cost-effective treatment option compared with dual therapies and MITT [ 20 – 23 ]. The evidence from the current study may be useful in informing clinical guidance on the optimum management strategy for patients with COPD, particularly those hospitalized due to a severe exacerbation.…”

Outcomes of patients with COPD switching from multiple-inhaler to once-daily single-inhaler triple therapy in a real-world primary care setting in England: a retrospective pre-post cohort study

“…Compared with MITT, SITT with FF/UMEC/VI has been shown to be a cost-effective treatment option for symptomatic patients with COPD who have a history of one or more exacerbations in a UK setting. 19 …”

Triple Therapy for COPD: Historical Perspective and Current Controversies

“…Third, not all open combinations are more expensive than fixeddose combinations, so cost-effectiveness studies are needed to assess the budgetary impact of this change at the level of the health system, taking into account the impact on the reduction of exacerbations and, therefore, the use of health resources. Currently, an initial evaluation of the cost-effectiveness of single versus multiple inhalers triple therapy indicates that a single-inhaler triple dose would improve health outcomes and reduce costs compared with open triple therapies for the treatment of patients with symptomatic COPD 48 .…”

“…Accordingly, this effect was also associated with significantly reduced use of health care resources and a subsequent reduction in the cost of care, with substantial adjusted mean annual cost savings. In addition, the 24-week INvestigation of TRelegy Effectiveness: usual PractIce Design (INTREPID) pragmatic trial demonstrated the clinical benefits of oncedaily single-inhaler triple therapy versus multiple-inhaler triple therapy in patients with symptomatic COPD 48 . Although the impact on prolongation of survival was not very striking, a reduction in the cost of treatment with triple therapy in a single inhalation device versus separate devices was observed, as mentioned above.…”

“…The INTREPID pragmatic trial investigated the clinical benefits of triple therapy versus continuing therapy with multiple-inhaler triple therapy for patients with symptomatic COPD in usual clinical practice 69 . The authors observed that using triple therapy in a single device was associated with an additional time of 0.174 life years, which corresponded to approximately two months 48 .…”