OBJECTIVES: To assess the cost-effectiveness of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus budesonide/formoterol (BUD/FOR) for patients with symptomatic COPD and a history of exacerbations from a China medical insurance system perspective based on data from the FULFIL trial (NCT02345161).

METHODS: This study adapted a previously published hybrid decision tree/Markov economic model (Schroeder et al. Respiratory Medicine. 2019). The initial decision tree replicated the outcomes in 24 weeks of the FULFIL trial. Outputs from the decision tree formed the starting position of the Markov model, which comprised six health states based on COPD severity and the presence/absence of recent exacerbation experience. The Markov was parameterized based on data from the three-year TORCH (The Towards a Revolution in COPD Health) study. Health state utilities were based on a cross-sectional study in China, and the disutilities of exacerbation events were sourced from published literature. China healthcare resource unit costs and drug costs were applied, with costs (2022 CNY ¥) and health outcomes discounted at 5% annually. The analysis was deterministic with a lifetime horizon. Scenario, one-way and probabilistic sensitivity analyses were performed to test the robustness of key assumptions and input parameter values.

RESULTS: Compared with BUD/FOR, FF/UMEC/VI provided an additional 0.678 life years (LYs) and 0.703 quality-adjusted life years (QALYs), with a cost saving of ¥11,493. Thus, FF/UMEC/VI was a dominant treatment versus BUD/FOR, and remained dominant across all scenario and one-way sensitivity analyses. In the probabilistic sensitivity analysis, FF/UMEC/VI was a dominant treatment option across all simulations and thus the probability that FF/UMEC/VI was cost-effective versus BUD/FOR was 100% at any willingness-to-pay threshold.

CONCLUSIONS: FF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a dominant treatment compared with BUD/FOR for patients with symptomatic COPD in China.