OBJECTIVES: To assess the cost-effectiveness of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus UMEC/VI for patients with symptomatic COPD and a history of exacerbations from a China medical insurance system perspective based on data from the IMPACT trial (NCT02164513).

METHODS: This study adapted a previously published hybrid decision tree/Markov economic model (Ismaila et al. Int J COPD. 2019). The initial trial-based decision tree model replicated the outcomes of the IMPACT trial (52 weeks). 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 exacerbations. 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 parameters.

RESULTS: Compared with UMEC/VI, FF/UMEC/VI provided an additional 0.195 life years (LYs) and 0.261 quality-adjusted life years (QALYs), with a cost saving of ¥6,003. Thus, FF/UMEC/VI was a dominant treatment versus UMEC/VI. FF/UMEC/VI remained a dominant treatment option across all scenario and one-way sensitivity analyses thus conducted. In the probabilistic sensitivity analysis, FF/UMEC/VI was a dominant treatment option across all simulations. At a willingness-to-pay threshold of ¥80,976/QALY (one GDP), the probability that FF/UMEC/VI was cost-effective versus UMEC/VI was 100%.

CONCLUSIONS: FF/UMEC/VI single-inhaler triple therapy improved health outcomes and was cost-saving compared with UMEC/VI for patients with symptomatic COPD and a history of exacerbations in China.