COST-EFFECTIVENESS OF SINGLE INHALER BUDESONIDE/GLYCOPYRRONIUM/FORMOTEROL FUMARATE DIHYDRATE VERSUS DUAL THERAPY ICS/LABA IN UNCONTROLLED ASTHMA: A UK PERSPECTIVE
Author(s)
Lotte Westerink, PhD1, Krishnali Parsekar, MSc1, Anthony Bentley, MSc2, Andre Verhoek, BSC, MSc, PhD3, Suzan Serip, PhD3, Chris Edmonds, -4, Rohit Katial, MD5.
1Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom, 2Petauri Evidence, Bicester, United Kingdom, 3Global Market Access and Pricing, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain, 4Global Price and Market Access, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA, 5Department of Medicine, National Jewish Health, Denver, CO, USA.
1Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom, 2Petauri Evidence, Bicester, United Kingdom, 3Global Market Access and Pricing, BioPharmaceuticals Medical, AstraZeneca, Barcelona, Spain, 4Global Price and Market Access, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA, 5Department of Medicine, National Jewish Health, Denver, CO, USA.
OBJECTIVES: To evaluate the long-term cost-effectiveness of budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF; 320/28.8/9.6 µg) versus medium-dose budesonide/formoterol fumarate dihydrate (BFF; 320/9 µg, an ICS/LABA) metered-dose inhaler in adolescents and adults with uncontrolled asthma requiring step-up therapy, from a UK National Health Service and Personal Social Services perspective.
METHODS: A cohort-based Markov model with monthly cycles and a lifetime horizon was developed. Costs and health outcomes were discounted at 3.5% per NICE guidance. Health states included non-exacerbation, severe exacerbation, withdrawal, and death, with non-exacerbation stratified by asthma control (ACQ-7 ≤0.75, >0.75-<1.5, ≥1.5). Severe exacerbations were categorised by healthcare resource use (systemic glucocorticosteroids [GCS] ≥3 times/day, emergency department visits with GCS, and inpatient hospitalisations). Clinical inputs, including annual severe exacerbation rate and asthma control distributions, were derived from prespecified pooled KALOS+LOGOS trial data. Annual exacerbation rates were converted to transition probabilities. The distribution of non-exacerbation health states beyond week 52 was assumed to remain stable over the modelled horizon; alternative assumptions were explored in scenario analyses. Health state utility values (mean, 0.73-0.90) were assigned according to asthma control levels. Costs (2025 GBP) included drug acquisition and exacerbation-related healthcare resource use (using UK national tariff sources).
RESULTS: BGF was associated with higher total costs (£939.41) but increased quality-adjusted-life-years (QALYs; 0.0987) versus ICS/LABA, resulting in an incremental cost-effectiveness ratio (ICER) of £9,521/QALY. Deterministic sensitivity analysis showed that results were robust to variation in key model inputs, with all analyses remaining within the UK willingness-to-pay (WTP) threshold of £25,000-£35,000/QALY. Key cost drivers included maintenance inhalation use, utility values for uncontrolled asthma, and long-term asthma control distribution. Probabilistic sensitivity analysis further supported the robustness, with BGF remaining cost-effective versus ICS/LABA in most simulations under the WTP threshold.
CONCLUSIONS: BGF is likely a cost-effective treatment option compared with ICS/LABA for patients with uncontrolled asthma requiring step-up therapy in the UK
METHODS: A cohort-based Markov model with monthly cycles and a lifetime horizon was developed. Costs and health outcomes were discounted at 3.5% per NICE guidance. Health states included non-exacerbation, severe exacerbation, withdrawal, and death, with non-exacerbation stratified by asthma control (ACQ-7 ≤0.75, >0.75-<1.5, ≥1.5). Severe exacerbations were categorised by healthcare resource use (systemic glucocorticosteroids [GCS] ≥3 times/day, emergency department visits with GCS, and inpatient hospitalisations). Clinical inputs, including annual severe exacerbation rate and asthma control distributions, were derived from prespecified pooled KALOS+LOGOS trial data. Annual exacerbation rates were converted to transition probabilities. The distribution of non-exacerbation health states beyond week 52 was assumed to remain stable over the modelled horizon; alternative assumptions were explored in scenario analyses. Health state utility values (mean, 0.73-0.90) were assigned according to asthma control levels. Costs (2025 GBP) included drug acquisition and exacerbation-related healthcare resource use (using UK national tariff sources).
RESULTS: BGF was associated with higher total costs (£939.41) but increased quality-adjusted-life-years (QALYs; 0.0987) versus ICS/LABA, resulting in an incremental cost-effectiveness ratio (ICER) of £9,521/QALY. Deterministic sensitivity analysis showed that results were robust to variation in key model inputs, with all analyses remaining within the UK willingness-to-pay (WTP) threshold of £25,000-£35,000/QALY. Key cost drivers included maintenance inhalation use, utility values for uncontrolled asthma, and long-term asthma control distribution. Probabilistic sensitivity analysis further supported the robustness, with BGF remaining cost-effective versus ICS/LABA in most simulations under the WTP threshold.
CONCLUSIONS: BGF is likely a cost-effective treatment option compared with ICS/LABA for patients with uncontrolled asthma requiring step-up therapy in the UK
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE422
Topic
Clinical Outcomes, Economic Evaluation
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)