OBJECTIVES : In Italy, fixed combinations of Long-Acting Muscarinic Antagonists (LAMA)/Long Acting Beta Agonist (LABA) and LAMA/LABA/inhaled corticosteroids (ICS) can be prescribed only by pneumologists. The objective of the analysis is to assess the economic consequences for the Regional Health Service (RHS) of Lombardy Region of including general practitioners (GPs) among the professionals allowed to prescribe LAMA/LABA and LAMA/LABA/ICS.

METHODS : A decision analytic model with a 1 year time horizon was implemented assuming the RHS perspective, considering the population eligible to a switch from LAMA or LABA/ICS to LAMA/LABA, and from LABA/ICS or LABA/LAMA+ICS to LAMA/LABA/ICS. The variables considered were assessed by experts (regional government representatives, pneumologists, GPs, pharmacists and health economists) and defined considering published literature (incidence of exacerbations and of pneumonia). Direct medical costs (year 2019) related to COPD treatments (retail price), clinical events and patients monitoring were included.

RESULTS : The annual per patient impact on direct costs of each switch is reported below:

- from LAMA to LAMA/LABA: between +149 € and -34 € (+2.5 million € and -575,000 € overall);

- from LABA/ICS to LAMA/LABA: between +197 € and -272 € (+4.5 million € and -6.3 million € overall);

- from LABA/ICS to LAMA/LABA/ICS: between +120 € and +337 € (+2.8 million € and +7.8 million € overall);

- LAMA/LABA+ICS to LAMA/LABA/ICS: between -172 € and -176 € (-4.0 million € and -4.8 million € overall).

CONCLUSIONS : The possibility to include GPs among the professionals allowed to prescribe LAMA/LABA and LAMA/LABA/ICS would lead to different economic results based on the type of switch (from +7.8 million € to -4.8 million € overall), however, the impact would be negligible, considering that regional healthcare expenditures are higher than 20 billion €. From a clinical perspective the switches considered would lead to a reduction of clinical events.