OBJECTIVES: The 52-week ETHOS study (NCT02465567) showed that fixed-dose triple therapy with budesonide/glycopyrronium/formoterol fumarate 320/14.4/10 µg (BGF 320) reduced moderate or severe chronic obstructive pulmonary disease (COPD) exacerbations versus fixed-dose long-acting muscarinic antagonist (LAMA)/long-acting β₂-agonist (LABA) or inhaled corticosteroid (ICS)/LABA dual therapy (Rabe et al. N Engl J Med 2020;383:35–48). Here, ETHOS data are used to estimate the cost-effectiveness of BGF 320 versus LAMA/LABA and ICS/LABA dual therapies in the United Kingdom.

METHODS: Incurred costs and quality-adjusted life-years (QALYs) for patients with moderate-to-very severe COPD were extrapolated using a Markov model, which considered progression in severity (lung function decline), occurrence of moderate and severe exacerbations, adverse events, and discontinuations from the ETHOS study for BGF 320, the LAMA/LABA glycopyrronium/formoterol fumarate 14.4/10 µg (GFF), and the ICS/LABA budesonide/formoterol fumarate 320/10 µg (BFF). Healthcare resource utilization was based on ETHOS data; unit costs came from UK National Health Service reference costs, the Personal Social Services Research Unit manual and the published literature. EuroQoL 5-dimension 5-level utilities for COPD severity states were estimated from ETHOS; exacerbation disutilities were sourced from a systematic literature review. A lifetime horizon was considered. Costs and QALYs were discounted at 3.5% per annum.

RESULTS: For BGF 320 versus GFF and BFF, respectively, incremental costs were £3136 and £1066, incremental QALYs were 0.23 and 0.49, and incremental exacerbation reductions were –2.45 and –1.86. The incremental cost-utility ratios (ICUR) were £13,700 and £2164 per QALY gained versus GFF and BFF, respectively.

CONCLUSIONS: Based on ETHOS data, BGF 320 is cost-effective versus LAMA/LABA and ICS/LABA dual therapy at the conventional UK-adopted willingness to pay (ICUR< £20,000 per QALY). The main cost-effectiveness driver was the reduction in exacerbation rate, which reduced costs and preserved quality of life, for BGF 320 versus LAMA/LABA and ICS/LABA therapies.