OBJECTIVES: The 2017 GOLD Report recommends triple therapy with an inhaled corticosteroid (ICS), a long acting beta2 agonist (LABA), and a long acting muscarinic antagonist (LAMA) for symptomatic and chronic obstructive pulmonary disease (COPD) patients who continue to experience exacerbations. Triple therapy is currently administered by using multiple inhalers, often with different posologies, which may reduce adherence leading to sub-optimal treatment. A first-in-class triple fixed dose combination (FDC) containing beclomethasone dipropionate (BDP), formoterol fumarate (FF) and glycopyrronium, in an extra fine formulation and a pMDI inhaler with dose counter, is indicated as maintenance treatment in adult patients with moderate to severe COPD who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting beta2-agonist. This study assesses the cost effectiveness of the triple FDC compared with other treatment options available.

METHODS: A five state Markov state-transition cohort model was built based on GOLD 2017 classification of airflow limitation (mild, moderate, severe, and very severe) and death. The probability of a severe or moderate exacerbation was applied to each state. Transition probabilities and treatment specific utilities were derived from pivotal trials, and the lung function (FEV) decline modelled beyond the trials. Trial comparators models include ICS/LABA (BDP/FF), LAMA alone (tiotropium) and open triple therapy (BDP/FF + tiotropium). UK costs and figures were used as default case.

RESULTS: Triple FDC therapy is dominant over open triple therapy, as it is similarly effective in most scenarios and has a lower drug acquisition cost. It provides more Quality Adjusted Life Years (QALYs) than either LAMA alone or ICS/LABA (largest QALY gains of 0.4 and 0.2 respectively) at an additional cost per patient of less than £1,000. Cost per QALY gained is well below NICE thresholds.

CONCLUSIONS: The new triple FDC therapy for COPD is cost effective as compared to open triple therapy, LAMA alone or ICS/LABA.