OBJECTIVES: The 2022 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommends long-acting muscarinic antagonist/long-acting beta₂-agonist (LAMA/LABA) combination therapy, rather than monotherapy, as initial treatment for COPD patients with breathlessness and/or exercise limitation. Triple therapy (TT) with inhaled corticosteroids/LABA/LAMA is not recommended as initial treatment but is suggested for patients who develop further exacerbations on dual therapy. Existing literature suggests TT is prescribed in discordance with these recommendations, and that the recent availability of fixed-dose combination (FDC) TT inhalers may increase discordant use. This budget impact model (BIM) focuses on COPD patients initiating FDC TT in discordance with GOLD recommendations to identify potential cost savings from a payer perspective.

METHODS: For a hypothetical population of 100,000 adult members, an Excel-based BIM was developed to assess the impact of patients initiating TT in discordance with GOLD recommendations. This included patients initiating as first-line maintenance therapy and/or whose exacerbation history classified them as GOLD A/B (with 0-1 exacerbations not leading to hospitalization in the prior 12 months). The model postulated a hypothetical scenario where these patients instead initiated LAMA/LABA therapy with tiotropium/olodaterol (TIO/OLO) and the incremental costs per-member-per-year (PMPY) were calculated. Model parameters included COPD prevalence, use of TT, and annual disease-related costs associated with treatment. Data was extracted from government reports, published literature and a recently completed administrative claims analysis. Costs were adjusted to 2021 USD using the Medical Care Component of the Consumer Price Index.

RESULTS: For a health plan with 100,000 adult members, the incremental impact of having GOLD-discordant FDC TT patients initiate TIO/OLO instead was found to yield PMPY savings between $0.29 to $2.85 (medical: $0.13 to $1.33; pharmacy: $0.15 to $1.52).