Impact of Budesonide-Glycopyrronium Formoterol Initiation on Healthcare Resource Utilization and Carbon Emissions in Patients With COPD in Spain: Insights From the ORESTES Study
Author(s)
Néstor Martínez Martínez, PhD1, Alba Ancochea, MBA1, Teresa Lastres, MBA1, Covadonga Torres, .1, Carmen Corregidor García, MSc2, Joaquín Sánchez-Covisa Hernández, MSc2, Juan Marco Figueira-Gonçalves, MD3, Bernardino Alcázar-Navarrete, MD4.
1Corporate Affairs and Market Access Department, Biopharmaceuticals, AstraZeneca, Madrid, Spain, 2Medical and Regulatory Affairs Department, Biopharmaceuticals Medical, AstraZeneca, Madrid, Spain, 3Pneumology Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain, 4Pneumology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.
1Corporate Affairs and Market Access Department, Biopharmaceuticals, AstraZeneca, Madrid, Spain, 2Medical and Regulatory Affairs Department, Biopharmaceuticals Medical, AstraZeneca, Madrid, Spain, 3Pneumology Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain, 4Pneumology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.
OBJECTIVES: To evaluate the impact of initiating treatment with budesonide/glycopyrronium/ formoterol (BGF) on healthcare resource utilization (HCRU), carbon footprint, and associated costs in patients with chronic obstructive pulmonary disease (COPD) in Spain.
METHODS: ORESTES was a retrospective, observational study, conducted in 20 Spanish hospitals, including 718 adults aged ≥40 years with COPD who initiated BGF (between 2022 and 2023). The analysis included data on hospitalizations, emergency room (ER) admissions, primary care (PC), and specialist visits, as well as rescue treatment use, across two time periods: 12 months before and 12 months after BGF initiation. Greenhouse gas (GHG) emission factors per HCRU and use of the main reliever, short-acting beta agonist (SABA), were applied to estimate environmental impact. GHG emissions from maintenance therapies were excluded, as a regulatory application for BGF with a next-generation, near-zero global warming potential propellant is currently under review in Europe, and anticipated approval is in 2025 - which will make its carbon footprint comparable to inhaled medicines that do not require a propellant. Costs and emissions were based on relevant published literature from the Spanish National Health System perspective.
RESULTS: After initiating BGF treatment, a 7.7% reduction in total healthcare costs was observed, mainly driven by the decrease in hospitalization days (9.2%), resulting in estimated annual savings of €197,661 per 1,000 patients (€198 per patient). In addition, the use of SABA declined by 24.4%, reflecting better disease control and reduced dependence on rescue medication. These observed reductions in HCRU and SABA use resulted in an estimated GHG decrease of 19,904 kg CO₂eq emissions per 1,000 patients (equivalent to 110,455 car kilometers), reinforcing the clinical and ecological value of optimized COPD management.
CONCLUSIONS: Reductions in hospitalizations, costs, and carbon emissions were observed after BGF initiation, suggesting that better disease control can drive both better clinical outcomes and greater environmental sustainability.
METHODS: ORESTES was a retrospective, observational study, conducted in 20 Spanish hospitals, including 718 adults aged ≥40 years with COPD who initiated BGF (between 2022 and 2023). The analysis included data on hospitalizations, emergency room (ER) admissions, primary care (PC), and specialist visits, as well as rescue treatment use, across two time periods: 12 months before and 12 months after BGF initiation. Greenhouse gas (GHG) emission factors per HCRU and use of the main reliever, short-acting beta agonist (SABA), were applied to estimate environmental impact. GHG emissions from maintenance therapies were excluded, as a regulatory application for BGF with a next-generation, near-zero global warming potential propellant is currently under review in Europe, and anticipated approval is in 2025 - which will make its carbon footprint comparable to inhaled medicines that do not require a propellant. Costs and emissions were based on relevant published literature from the Spanish National Health System perspective.
RESULTS: After initiating BGF treatment, a 7.7% reduction in total healthcare costs was observed, mainly driven by the decrease in hospitalization days (9.2%), resulting in estimated annual savings of €197,661 per 1,000 patients (€198 per patient). In addition, the use of SABA declined by 24.4%, reflecting better disease control and reduced dependence on rescue medication. These observed reductions in HCRU and SABA use resulted in an estimated GHG decrease of 19,904 kg CO₂eq emissions per 1,000 patients (equivalent to 110,455 car kilometers), reinforcing the clinical and ecological value of optimized COPD management.
CONCLUSIONS: Reductions in hospitalizations, costs, and carbon emissions were observed after BGF initiation, suggesting that better disease control can drive both better clinical outcomes and greater environmental sustainability.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE526
Topic
Clinical Outcomes, Economic Evaluation, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Novel & Social Elements of Value
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)