Indacaterol/glycopyrronium is cost-effective compared to salmeterol/fluticasone in COPD: FLAME-based modelling in a Swedish population

Abstract

BackgroundThis study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year.MethodsA previously published and validated patient-level simulation model was adapted using clinical data from the FLAME trial and real-world cost data from the ARCTIC study. Costs (total monetary costs comprising drug, maintenance, exacerbation, and pneumonia costs) and health outcomes (life-years (LYs), quality-adjusted life-years (QALYs)) were projected over various time horizons (1, 5, 10 years, and lifetime) from the Swedish payer’s perspective and were discounted at 3% annually. Uncertainty in model input values was studied through one-way and probabilistic sensitivity analyses. Subgroup analyses were also performed.ResultsIND/GLY was associated with lower costs and better outcomes compared with SFC over all the analysed time horizons. Use of IND/GLY resulted in additional 0.192 LYs and 0.134 QALYs with cost savings of €1211 compared with SFC over lifetime. The net monetary benefit (NMB) was estimated to be €8560 based on a willingness-to-pay threshold of €55,000/QALY. The NMB was higher in the following subgroups: severe (GOLD 3), high risk and more symptoms (GOLD D), females, and current smokers.ConclusionIND/GLY is a cost-effective treatment compared with SFC in COPD patients with mMRC dyspnea grade ≥ 2, moderate to very severe airflow limitation, and ≥1 exacerbation in the preceding year.Electronic supplementary materialThe online version of this article (10.1186/s12931-017-0688-5) contains supplementary material, which is available to authorized users.

<p>Modelling the Cost-Effectiveness of Indacaterol/Glycopyrronium versus Salmeterol/Fluticasone Using a Novel Markov Exacerbation-Based Approach</p>

“…To address this limitation, patient-level (or micro) simulation models have been developed, which consider a much broader range of clinical events and complications, such as exacerbations, symptom worsening, pneumonia and changes in health-related quality of life (HRQoL). [16][17][18][19][20] Such models include a recent patient-level simulation model that included 14 patient characterstics, seven intermediate outcomes (eg lung function, exacerbations, and pnemonias) and three final outcomes (mortality, qualityadjusted life years [QALYs] and costs), which allowed for evaluation of the effect of treatment for various subgroups of COPD patients. 21 Indacaterol/glycopyrronium (IND/GLY) was the first LABA/LAMA combination to be approved for the treatment of COPD and consequently, its cost-effectiveness has been studied extensively, [16][17][18][19]22,23 including via microsimulation modelling.…”

“…[16][17][18][19][20] Such models include a recent patient-level simulation model that included 14 patient characterstics, seven intermediate outcomes (eg lung function, exacerbations, and pnemonias) and three final outcomes (mortality, qualityadjusted life years [QALYs] and costs), which allowed for evaluation of the effect of treatment for various subgroups of COPD patients. 21 Indacaterol/glycopyrronium (IND/GLY) was the first LABA/LAMA combination to be approved for the treatment of COPD and consequently, its cost-effectiveness has been studied extensively, [16][17][18][19]22,23 including via microsimulation modelling. 18,20 In the microsimulation model, 20 IND/GLY was shown to be cost-effective compared with the LABA/ inhaled corticosteroid (ICS) combination salmeterol/fluticasone (SFC) in patients at risk of exacerbations.…”

“…21 Indacaterol/glycopyrronium (IND/GLY) was the first LABA/LAMA combination to be approved for the treatment of COPD and consequently, its cost-effectiveness has been studied extensively, [16][17][18][19]22,23 including via microsimulation modelling. 18,20 In the microsimulation model, 20 IND/GLY was shown to be cost-effective compared with the LABA/ inhaled corticosteroid (ICS) combination salmeterol/fluticasone (SFC) in patients at risk of exacerbations. 20 The incremental costs and incremental QALYs from the model were informed predominantly by exacerbation rates.…”

“…20 The incremental costs and incremental QALYs from the model were informed predominantly by exacerbation rates. 18,20 However, the microsimulation model is complex relative to other model types, takes a long time to run, and is not easily understood by policy-makers.…”

“…The model was based on clinical data from the FLAME study, which reported the annual rate of moderate and severe exacerbations to be 17% lower with IND/GLY than SFC in patients with a history of moderate exacerbation in the previous year. 24 We sought to validate the model by comparing our results to the previously published microsimulation cost-effectiveness analysis, 18 which also used data from the FLAME study and used the same inputs 20 as our analysis.…”