OBJECTIVES: COPD is a life-threatening and progressive condition with no known cure and is a major cause of morbidity and mortality in the United States. Revefenacin for nebulization is a once-daily, long-acting muscarinic antagonist (LAMA), which is recently approved for maintenance treatment of COPD. This study evaluated the budget impact to a US health plan of introducing revefenacin into the treatment landscape.

METHODS: A budget impact model was developed in Microsoft Excel^® from a US third-party payer perspective. The treatment eligible population was adult patients with moderate to very severe COPD, and comparators included nebulized and handheld therapies approved for treatment of COPD and having relevant market share. Cost estimates were determined for a hypothetical health plan with 1 million members. Default drug cost and dosing information were derived from prescribing information and the MediSpan PriceRx database. Published literature informed population size, exacerbation rates and costs. Remaining inputs were derived from CMS fee schedules and proprietary market share data sources. One-way sensitivity analysis was conducted on model inputs to evaluate the impact of uncertainty on results.

RESULTS: For a hypothetical plan of 1 million covered lives, 488 moderate to severe COPD patients were eligible for treatment in year 1. The associated relative budget impact was 0.67% or $0.20 per member per month (PMPM) in year 1, and 1.21% or $0.36 PMPM over years 1-3. Increased drug acquisition costs were partially offset by savings in exacerbation management costs. Sensitivity analysis showed that PMPM results were most sensitive to factors affecting the number of patients eligible for treatment (such as prevalence of COPD, adherence and proportion of patients with severe COPD) and revefenacin market share.

CONCLUSIONS: Revefenacin is a recently available option for moderate to very severe COPD, with a manageable budget impact to a US health plan.