OBJECTIVES: Indacaterol acetate/glycopyrronium bromide/mometasone furoate (IND/GLY/MF) is currently the only triple inhalation therapy approved for asthma indication in China and has demonstrated favorable clinical outcomes in Phase III trials. This study aims to evaluate the cost-effectiveness of IND/GLY/MF compared to salmeterol/fluticasone+tiotropium bromide (SAL/FLU+TIO) and SAL/FLU, respectively, for the treatment of adult patients with uncontrolled moderate-to-severe asthma.

METHODS: A Markov model was constructed from the perspective of the Chinese healthcare system, encompassing four states: no asthma exacerbation, mild-to-moderate acute exacerbation, severe acute exacerbation, and death. Patients with mild to moderate acute exacerbations are assumed to self-manage to relieve acute asthma exacerbations. Severe acute exacerbations are further divided into three sub-states based on subsequent treatment measures: outpatient, ED visit, and hospitalization. The model cycle was two weeks, and the time horizon was the patient's lifetime. The primary outcomes were quality-adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER). Exacerbation rates were derived from ARGON and IRIDIUM clinical trials. Mortality rates, costs, and utility values were sourced from public databases and published literature. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of input parameters.

RESULTS: Compared to SAL/FLU+TIO, IND/GLY/MF had lower costs (¥90,519.57 vs. ¥200,964.51) and higher QALYs (15.04 QALYs vs. 14.14 QALYs), demonstrating absolute dominance. Compared to SAL/FLU, IND/GLY/MF had higher costs (¥91,547.21 vs. ¥89,348.86) but higher QALYs (14.50 QALYs) vs. 12.34 QALYs), with an ICER of ¥1,015/QALY. IND/GLY/MF was cost-effective at the willingness-to-pay threshold of ¥89,358/QALY (1x China's GPD per capita). The base case results in sensitivity analysis were robust to all assumptions and parameter changes.

CONCLUSIONS: The single-inhaler IND/GLY/MF offered better clinical efficacy and was considered cost-effective with increased QALY gain for the maintenance therapy in Chinese patients with moderate-to-severe uncontrolled asthma.