OBJECTIVES

: This study assessed the cost-effectiveness of a fixed-dose combination of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in treating patients with moderate to very severe chronic obstructive pulmonary disease (COPD) with ≥1 exacerbation in the previous year.

METHODS

: A model simulation was conducted using a published patient-level model which included COPD patients aged ≥40 years. Clinical data was obtained from the FLAME study and real-world cost data from Taiwan’s National Health Insurance claims data. The intervention as fixed-dose IND/GLY once daily and the comparator was SFC twice daily. Outcomes of this study were life years, quality-adjusted life years (QALYs), direct medical costs (including drug costs, maintenance costs, exacerbation costs and influenza/pneumonia costs), and incremental cost-effectiveness ratios (ICERs). The simulation time horizon was lifetime and the cycle length was 6 months to match forced expiratory volume in 2 second (FEV1) data. The discount rate of cost and benefits is 3%. the price year is 2017 and all costs are expressed in US Dollars (US$). One-way sensitivity analysis (OWSA) and probabilistic sentivity analysis (PSA) were conduced to estimate the impact of uncertainty of key parameters.

RESULTS

: When compared to SFC, moderate to very severe COPD patients who received IND/GLY as maintenance treatment gained 0.13 QALY at an additional cost of US$1,295.5, yielding an ICER of US$9,718 per QALY gained. The OWSA showed that the main drivers of ICER were cost of IND/GLY, cost of SFC and exacerbation rate ratio of IND/GLY. In PSA, when using 1 GDP per capita of Taiwan as the threshold, the probability of IND/GLY being cost effective compared with SFC was 100%.

CONCLUSIONS

: From the perspective of NHIA, using IND/GLY once daily as maintenance treatment for moderate to very severe COPD patients with ≥1 exacerbation in the previous year could be considered as cost-effectiveness when compared to SFC twic edialy.