OBJECTIVES: The goal of COPD management is to alleviate symptoms, decrease exacerbation frequency and severity, and improve health status. Standard of care (SOC) therapy is administered via hand-held devices, but some patients may benefit from utilizing a nebulizer. Revefenacin, a once-daily, long-acting muscarinic antagonist (LAMA) delivered via nebulization, is recently approved for maintenance treatment of COPD. This analysis evaluates lifetime outcomes, costs, and cost-effectiveness of adding revefenacin to SOC (revefenacin + SOC) compared with SOC alone.

METHODS: A semi-Markov/area-under-the-curve (AUC) model was developed in Microsoft Excel^® to estimate clinical outcomes (forced expiratory volume in one second [FEV1], exacerbations, life-years [LYs] and quality-adjusted life years [QALYs]) and costs (primary treatment, background COPD management, and exacerbations) for adults with moderate to very severe COPD. Inputs were obtained from revefenacin trials, published literature and CMS fee schedules. All costs (in 2018 USD) and outcomes were discounted at 3% annually and reported from the US third-party payer perspective. Scenario/sensitivity analyses explored the impact of data choices and assumptions.

RESULTS: The base case analysis showed that revefenacin + SOC resulted in better lung function over time (ΔFEV1=130.7mL); fewer exacerbations (Δ=6.59); and increased LYs (Δ=0.14) and QALYs (Δ=0.18), vs SOC alone. Lower costs for exacerbation management partially offset higher medication costs. Incremental total medical costs were $19,745, which resulted in an incremental cost-effectiveness ratio (ICER) of $112,301/QALY. Sensitivity analysis identified revefenacin impact on exacerbation rates as a key driver of cost-effectiveness. Revefenacin + SOC was more cost-effective in those patients on concurrent long-acting beta agonists (LABA) ($105,890/QALY) or with stage III/IV disease ($21,116/QALY).

CONCLUSIONS: Revefenacin treatment was associated with improved FEV1, reduced exacerbations and improved survival. It also represents a cost-effective treatment alternative for maintenance therapy for moderate to very severe COPD patients, according to widely accepted cost-effectiveness thresholds in the United States.