COST-EFFECTIVENESS ANALYSIS OF SINGLE-INHALER EXTRAFINE BECLOMETHASONE/FORMOTEROL/GLYCOPYRRONIUM BROMIDE FOR ADULT PATIENTS WITH UNCONTROLLED ASTHMA FROM THE BRAZILIAN PUBLIC HEALTHCARE SYSTEM PERSPECTIVE
Author(s)
Frederico Sallum, MSc1, Tulio Tadeu Rocha Sarmento, MSc, PharmD2, Alexandra Mariano Fidêncio, MSc1, Wender De Oliveira, BA, MA, MBA1.
1Chiesi Brazil, São Paulo, Brazil, 2Precision Data Engineering & Data Science, Contagem, Brazil.
1Chiesi Brazil, São Paulo, Brazil, 2Precision Data Engineering & Data Science, Contagem, Brazil.
OBJECTIVES: To evaluate the cost-effectiveness of single-inhaler extrafine medium-strength beclomethasone/formoterol/glycopyrronium bromide (BDP/FOR/GLY) compared with medium- and high-dose inhaled corticosteroid/long-acting β₂-agonist (ICS/LABA) dual therapy in adult patients with uncontrolled asthma eligible for step 4 or step 5 treatment according to the Brazilian Clinical Protocol and Therapeutic Guidelines, from the Brazilian public healthcare system perspective.
METHODS: A cohort-based Markov state-transition model was developed in Microsoft Excel following the Brazilian methodological guidelines for economic evaluation and CHEERS recommendations. The model comprised five mutually exclusive health states: no exacerbation, moderate exacerbation, severe exacerbation without hospitalization, severe exacerbation requiring hospitalization, and death. Transition probabilities were estimated from individual patient data from the TRIMARAN trial over consecutive follow-up periods and extrapolated over a lifetime horizon. Costs included drug acquisition, disease management, and hospitalization using Brazilian public reimbursement databases (SIGTAP, BPS, and DATASUS). Health outcomes were measured as quality-adjusted life-years (QALYs). Costs and outcomes were discounted at 5% annually. One-way and probabilistic sensitivity analyses were performed.
RESULTS: BDP/FOR/GLY resulted in 11.92 QALYs at a lifetime cost of BRL 19,589, compared with 11.81 QALYs and BRL 29,040 for medium-dose ICS/LABA and 11.89 QALYs and BRL 40,164 for high-dose ICS/LABA. Therefore, BDP/FOR/GLY was a dominant treatment alternative compared with both comparators, providing greater health benefits while reducing lifetime healthcare costs by approximately BRL 9,500 and BRL 20,600 per patient, respectively. One-way sensitivity analysis demonstrated that the findings were robust to parameter uncertainty. In the probabilistic sensitivity analysis, 97.1% and 88.1% of simulations were located in the southeast quadrant of the cost-effectiveness plane versus medium- and high-dose ICS/LABA, respectively, indicating a high likelihood of BDP/FOR/GLY being dominant.
CONCLUSIONS: The results support the adoption of BDP/FOR/GLY as a dominant treatment alternative compared with medium- and high-dose ICS/LABA for adult patients with uncontrolled asthma within the Brazilian public healthcare system.
METHODS: A cohort-based Markov state-transition model was developed in Microsoft Excel following the Brazilian methodological guidelines for economic evaluation and CHEERS recommendations. The model comprised five mutually exclusive health states: no exacerbation, moderate exacerbation, severe exacerbation without hospitalization, severe exacerbation requiring hospitalization, and death. Transition probabilities were estimated from individual patient data from the TRIMARAN trial over consecutive follow-up periods and extrapolated over a lifetime horizon. Costs included drug acquisition, disease management, and hospitalization using Brazilian public reimbursement databases (SIGTAP, BPS, and DATASUS). Health outcomes were measured as quality-adjusted life-years (QALYs). Costs and outcomes were discounted at 5% annually. One-way and probabilistic sensitivity analyses were performed.
RESULTS: BDP/FOR/GLY resulted in 11.92 QALYs at a lifetime cost of BRL 19,589, compared with 11.81 QALYs and BRL 29,040 for medium-dose ICS/LABA and 11.89 QALYs and BRL 40,164 for high-dose ICS/LABA. Therefore, BDP/FOR/GLY was a dominant treatment alternative compared with both comparators, providing greater health benefits while reducing lifetime healthcare costs by approximately BRL 9,500 and BRL 20,600 per patient, respectively. One-way sensitivity analysis demonstrated that the findings were robust to parameter uncertainty. In the probabilistic sensitivity analysis, 97.1% and 88.1% of simulations were located in the southeast quadrant of the cost-effectiveness plane versus medium- and high-dose ICS/LABA, respectively, indicating a high likelihood of BDP/FOR/GLY being dominant.
CONCLUSIONS: The results support the adoption of BDP/FOR/GLY as a dominant treatment alternative compared with medium- and high-dose ICS/LABA for adult patients with uncontrolled asthma within the Brazilian public healthcare system.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE115
Topic
Economic Evaluation, Health Technology Assessment, Study Approaches
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)