Cost-Effectiveness of Umeclidinium/Vilanterol (UMEC/VI) Versus Tiotropium/Olodaterol (TIO/OLO) in Patients With COPD: United Kingdom Payer Perspective

OBJECTIVES: This analysis assessed the cost-effectiveness of umeclidinium/vilanterol (UMEC/VI) versus tiotropium/olodaterol (TIO/OLO) for the treatment of chronic obstructive pulmonary disease (COPD), from a United Kingdom (UK) National Healthcare System perspective.

METHODS: The GALAXY model (Briggs, 2017 Med Decis Making 37:4) is a validated and extensively published economic model employing a linked risk-equation approach to model COPD disease progression. For the purposes of this analysis, the GALAXY model was populated with patient characteristics (pooled) and treatment effects (change from baseline in forced expiratory volume in 1 second [FEV₁] and in St George’s Respiratory Questionnaire [SGRQ]) from a recent study (NCT02799784; Feldman, 2017 Adv Ther 34:2518–2533). This study was an 8-week, multicenter crossover clinical trial in symptomatic patients with COPD of once-daily UMEC/VI 62.5/25 mcg versus once-daily TIO/OLO 5/5 mcg.

Model outputs included estimated exacerbation rates, costs, life-years (LYs), and quality-adjusted LYs (QALYs). UK healthcare resource unit and drug costs were applied, with costs (£, 2022) and QALYs discounted at 3.5% annually. The incremental cost-effectiveness ratio (ICER) was presented as cost per QALY gained using a probabilistic analysis with a lifetime horizon. One-way sensitivity and scenario analyses were conducted to test robustness of the model results.

RESULTS: Treatment with UMEC/VI was predicted to result in 0.019 fewer total exacerbations per patient per year and provided an additional 0.216 LYs (95% confidence interval 0.077, 0.391) and 0.102 QALYs (0.038, 0.184), with cost savings of £1,259 (£853, £1,765) compared with TIO/OLO. UMEC/VI was consistently dominant versus TIO/OLO across all scenario and sensitivity analyses. Cost-savings were highest for the scenario where treatment discontinuation was applied in first and subsequent years.

CONCLUSIONS: Based on this analysis, UMEC/VI is a dominant (lower costs and better outcomes) treatment option compared with TIO/OLO for the treatment of COPD patients in the UK.