OBJECTIVES : Chronic obstructive pulmonary disease (COPD) is associated with a significant economic burden and is one of the most prevalent diseases in the world. This systematic literature review aimed to review and present recent economic burden associated with moderate to severe COPD, focusing on triple therapy

METHODS : The key biomedical databases MEDLINE, Embase and EconLit, were searched for this literature review from 2016 to January 2021.

RESULTS : A total of 3266 records were retrieved from database searches and 18 economic evaluations along with 24 cost and resource use studies were included. Single-inhaler triple therapy (SITT) was observed to be more cost-effective than multi-inhaler triple therapy (MITT). Compared to dual therapies, triple combination demonstrated more Quality Adjusted Life Years (QALYs) with fewer COPD exacerbations along with the incremental cost-effectiveness ratio (ICER) generally below the relevant national willingness to pay threshold. SITT of beclometasone dipropionate, formoterol fumarate, and glycopyrronium provided 0.24 more QALYs than LABA/LAMA therapy, resulting in an ICER of ≈ £3,900, well below the £20,000 per QALY threshold. The studies providing data on cost and resource use in patients with moderate to very severe COPD demonstrated that healthcare costs in COPD vary according to the patient’s disease severity with the frequency and severity of exacerbations having the greatest economic impact. Annual total direct healthcare cost ranged from € 3,821 (mild COPD) to € 7,801 (very severe COPD) while indirect cost ranged from € 11,846 (mild) to 22,932 (very severe) across Europe in 2018. Inpatient hospitalization costs followed by medication costs constituted the largest proportions of total direct costs.

CONCLUSIONS : There is significant economic burden associated with moderate to very severe COPD particularly related to more severe COPD. SITT has emerged as a cost-effective option for the treatment of patients with moderate to severe COPD, driven by the reduction of exacerbations.