Cost-Effectiveness of Fluticasone Furoate/Umeclidinium/Vilanterol in Elderly Patients With Severe to Very Severe Chronic Obstructive Pulmonary Disease
Author(s)
Thanyaporn Kuagoolsirirot, Ph.D. Candidate1, Thananan Rattanachotphanit, Ph.D.1, Onanong Waleekhachonloet, Ph.D.1, Supon Limwattananon, Ph.D.2, Chulaporn Limwattananon, Ph.D.3.
1Division of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand, 2International Health Policy Foundation, Bangkok, Thailand, 3Independent researcher, Khon Kaen, Thailand.
1Division of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand, 2International Health Policy Foundation, Bangkok, Thailand, 3Independent researcher, Khon Kaen, Thailand.
OBJECTIVES: In Thailand, a combined triple therapy inhaler for chronic obstructive pulmonary disease (COPD) is not currently included in the national list of essential medicines. The clinical benefits of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) as a triple therapy over budesonide/formoterol (BUD/FOR), which is a wide use regimen, have been demonstrated in patients with advanced COPD. This study aimed to evaluate the cost-effectiveness of once-daily FF/UMEC/VI compared to twice-daily BUD/FOR in elderly patients with severe to very severe COPD in Thailand from a societal perspective.
METHODS: A Markov model was used to simulate lifetime cost (in 2024 US$) and quality-adjusted life years (QALYs). The initial cohorts were COPD patients aged 65 years, classified as GOLD 3 and 4, with high symptom burden and high risk of exacerbations. Disease progression was modeled based on forced expiratory volume in one second (FEV1) and the annual rate of FEV1 decline in Thai patients. Treatment effects including improvements in trough FEV1, quality of life, exacerbation rate reduction, and decreased use of rescue medication for dyspnea were derived from clinical trials. Costs were based on hospital and claim data. Utility scores were derived from total scores of St George’s Respiratory Questionnaire (SGRQ) in Thai COPD patients. Cost and QALYs were discounted at 3% per year.
RESULTS: Compared with BUD/FOR, treatment with FF/UMEC/VI provides an additional 0.48 life-years and 0.47 QALYs and an additional cost of US$1860, resulting in an incremental cost-effectiveness ratio (ICER) of US$3983 per QALY. The ICER was below the willingness-to-pay (WTP) threshold (US$4533) established for Thailand. Probabilistic sensitivity analysis confirmed that the results were robust.
CONCLUSIONS: Once-daily FF/UMEC/VI is a cost-effective treatment option for elderly patients with severe to very severe COPD, compared with twice-daily BUD/FOR in Thailand.
METHODS: A Markov model was used to simulate lifetime cost (in 2024 US$) and quality-adjusted life years (QALYs). The initial cohorts were COPD patients aged 65 years, classified as GOLD 3 and 4, with high symptom burden and high risk of exacerbations. Disease progression was modeled based on forced expiratory volume in one second (FEV1) and the annual rate of FEV1 decline in Thai patients. Treatment effects including improvements in trough FEV1, quality of life, exacerbation rate reduction, and decreased use of rescue medication for dyspnea were derived from clinical trials. Costs were based on hospital and claim data. Utility scores were derived from total scores of St George’s Respiratory Questionnaire (SGRQ) in Thai COPD patients. Cost and QALYs were discounted at 3% per year.
RESULTS: Compared with BUD/FOR, treatment with FF/UMEC/VI provides an additional 0.48 life-years and 0.47 QALYs and an additional cost of US$1860, resulting in an incremental cost-effectiveness ratio (ICER) of US$3983 per QALY. The ICER was below the willingness-to-pay (WTP) threshold (US$4533) established for Thailand. Probabilistic sensitivity analysis confirmed that the results were robust.
CONCLUSIONS: Once-daily FF/UMEC/VI is a cost-effective treatment option for elderly patients with severe to very severe COPD, compared with twice-daily BUD/FOR in Thailand.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD321
Topic Subcategory
Reproducibility & Replicability
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)